Provider Demographics
NPI:1053454611
Name:SAMARITAN CENTER OF THE ROCKIES
Entity Type:Organization
Organization Name:SAMARITAN CENTER OF THE ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:PAPA
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:970-926-8558
Mailing Address - Street 1:PO BOX 19000 PMB 240
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-9010
Mailing Address - Country:US
Mailing Address - Phone:970-926-8558
Mailing Address - Fax:970-926-6845
Practice Address - Street 1:90 LARIAT LOOP
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-926-8558
Practice Address - Fax:970-926-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2411101YM0800X
CO4464101YM0800X
CO1811101YP1600X
CO6111041C0700X
CO356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty