Provider Demographics
NPI:1962920207
Name:MOUNT EVANS HOSPICE, INC.
Entity type:Organization
Organization Name:MOUNT EVANS HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-674-6400
Mailing Address - Street 1:3081 BERGEN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2200
Mailing Address - Country:US
Mailing Address - Phone:303-674-6400
Mailing Address - Fax:
Practice Address - Street 1:3081 BERGEN PEAK DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2200
Practice Address - Country:US
Practice Address - Phone:303-674-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871996124OtherMOUNT EVANS HOME HEALTH CARE & HOSPICE
1346284965OtherMOUNT EVANS HOSPICE, INC.