Provider Demographics
NPI:1194294686
Name:MANTO HOMES LLC
Entity type:Organization
Organization Name:MANTO HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-292-7277
Mailing Address - Street 1:3166 FRONTIER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5260
Mailing Address - Country:US
Mailing Address - Phone:720-292-7277
Mailing Address - Fax:
Practice Address - Street 1:7465 W 69TH PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-3411
Practice Address - Country:US
Practice Address - Phone:303-431-6575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility