Provider Demographics
NPI:1073186631
Name:ROCKY MOUNTAIN NG CORP
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN NG CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-597-5685
Mailing Address - Street 1:12998 MONACO WAY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8941
Mailing Address - Country:US
Mailing Address - Phone:720-597-5685
Mailing Address - Fax:
Practice Address - Street 1:11290 W ALAMEDA AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2511
Practice Address - Country:US
Practice Address - Phone:303-353-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONAOtherNA