Provider Demographics
NPI:1366618886
Name:DKM, INC.
Entity type:Organization
Organization Name:DKM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-568-7204
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0173
Mailing Address - Country:US
Mailing Address - Phone:970-568-7204
Mailing Address - Fax:970-568-0420
Practice Address - Street 1:8126 5TH STREET
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549
Practice Address - Country:US
Practice Address - Phone:970-568-7199
Practice Address - Fax:970-568-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54-08310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04182267Medicaid