1003433061 NPI number — ROCKY MOUTAIN MENTAL HEALTH P.C.

Table of content: ANTOINETTE MAKAREWICZ BSN, RN (NPI 1518307594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003433061 NPI number — ROCKY MOUTAIN MENTAL HEALTH P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUTAIN MENTAL HEALTH P.C.
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:
Provider Other Organization Name Type Code:
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:
1003433061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7345 S PIERCE ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80128-4592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-841-9270
Provider Business Mailing Address Fax Number:
720-770-1309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 S PIERCE ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80128-4592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-841-9270
Provider Business Practice Location Address Fax Number:
720-770-1309
Provider Enumeration Date:
06/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OLDHAM
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
720-770-1492

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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