Mike's Place LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MIKE'S PLACE LLC

Practice address

325 Garfield Avenue
Carbondale, CO 81623

Phone

(970) 319-8496

NPI assigned

Oct 14, 2020

Last updated

Oct 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebecca L Young

Title

Director

Phone

(970) 319-8496

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1043818719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 GARFIELD AVENUE",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "81623",
            "telephone_number": "970-319-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 GARFIELD AVENUE",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "81623",
            "telephone_number": "970-319-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKE'S PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "970-319-8496"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48808717",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridget Calland McClain, PHARMD
• Jordon McIlvain
• James Todd Means, OTR
• Mending Mountains Therapy PC
• Cynthia J Metzger, OTR
• Tyler Millard, MS, CF-SLP
• Christina Laudan Ahmadian Miller, MD
• Mindful Me Therapy LLC (Mindful Me Behavior Support)
• Mountain Family Health Centers
• Mountain Valley Developmental Services

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Carbondale, CO
• Providers in Carbondale, CO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.