Provider Demographics
NPI:1053324335
Name:LIVING CENTERS-ROCKY MOUNTAIN, INC.
Entity Type:Organization
Organization Name:LIVING CENTERS-ROCKY MOUNTAIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-443-6772
Mailing Address - Street 1:1 RAVINIA DR STE 1250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2112
Mailing Address - Country:US
Mailing Address - Phone:678-443-6772
Mailing Address - Fax:
Practice Address - Street 1:1 RAVINIA DR STE 1250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2112
Practice Address - Country:US
Practice Address - Phone:678-443-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY05-174-POPLAR314000000X
WY05-183-SHERIDAN314000000X
WY05-192-CHEYENNE314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY53-5026Medicare ID - Type UnspecifiedSHERIDAN MANOR
WY53-5025Medicare ID - Type UnspecifiedCHEYENNE HEALTHCARE CENTE
WY53-5024Medicare ID - Type UnspecifiedPOPLAR LIVING CENTER