Provider Demographics
NPI:1962801423
Name:MONTE VISTA ESTATES, LLC
Entity type:Organization
Organization Name:MONTE VISTA ESTATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-689-1808
Mailing Address - Street 1:2277 EAST DR
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-9330
Mailing Address - Country:US
Mailing Address - Phone:719-852-5138
Mailing Address - Fax:719-852-4012
Practice Address - Street 1:2277 EAST DR
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-9330
Practice Address - Country:US
Practice Address - Phone:719-852-5138
Practice Address - Fax:719-852-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPPLIED FOR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility