Provider Demographics
NPI:1306611561
Name:MINT HEALTH LLC
Entity type:Organization
Organization Name:MINT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-972-0647
Mailing Address - Street 1:235 N 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3401
Mailing Address - Country:US
Mailing Address - Phone:970-972-0647
Mailing Address - Fax:970-200-2396
Practice Address - Street 1:235 N 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3401
Practice Address - Country:US
Practice Address - Phone:970-972-0647
Practice Address - Fax:970-200-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care