Provider Demographics
NPI:1447440706
Name:ROCKY MOUNTAIN MS CENTER
Entity type:Organization
Organization Name:ROCKY MOUNTAIN MS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KADEP DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MS CTRS
Authorized Official - Phone:303-433-6887
Mailing Address - Street 1:8845 WAGNER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3553
Mailing Address - Country:US
Mailing Address - Phone:303-788-4030
Mailing Address - Fax:303-788-5418
Practice Address - Street 1:8845 WAGNER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031
Practice Address - Country:US
Practice Address - Phone:303-433-6887
Practice Address - Fax:303-433-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04140943Medicaid