Provider Demographics
NPI:1023204948
Name:UNIVERSITY OF NORTHERN COLORADO
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTHERN COLORADO
Other - Org Name:ROCKY MOUNTAIN CANCER REHABILITATION INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FOR ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-351-2772
Mailing Address - Street 1:10TH AVE AND 19TH ST
Mailing Address - Street 2:CAMPUS BOX 6
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-0001
Mailing Address - Country:US
Mailing Address - Phone:970-351-1876
Mailing Address - Fax:
Practice Address - Street 1:10TH AVE AND 19TH ST
Practice Address - Street 2:CAMPUS BOX 6
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-1876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation