Provider Demographics
NPI:1013554971
Name:ROCKY MOUNTAIN PERSONAL CARE - NEVADA, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PERSONAL CARE - NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:576 W 900 S STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8232
Mailing Address - Country:US
Mailing Address - Phone:801-397-4140
Mailing Address - Fax:801-397-4199
Practice Address - Street 1:6950 VIA OLIVERO AVE STE B4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2849
Practice Address - Country:US
Practice Address - Phone:801-397-4140
Practice Address - Fax:801-397-4199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHCCK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-10
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care