Provider Demographics
NPI:1144042979
Name:MANDALA CARE
Entity type:Organization
Organization Name:MANDALA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:720-641-4710
Mailing Address - Street 1:8020 LEE DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-2078
Mailing Address - Country:US
Mailing Address - Phone:720-996-8800
Mailing Address - Fax:833-823-4392
Practice Address - Street 1:8020 LEE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-2078
Practice Address - Country:US
Practice Address - Phone:720-996-8800
Practice Address - Fax:833-823-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty