1801893714 NPI number — ROCKY MOUNTAIN CARE

Table of content: (NPI 1801893714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801893714 NPI number — ROCKY MOUNTAIN CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROCKY MOUNTAIN CARE MANAGEMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801893714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
576 W. 900 S.
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
WOODS CROSS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-8127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-397-4054
Provider Business Mailing Address Fax Number:
801-397-4196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5250 COMMERCE DR
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-7926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-397-4000
Provider Business Practice Location Address Fax Number:
801-397-4959
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BANGERTER
Authorized Official First Name:
DEE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
801-397-4000

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  10006-05 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com