Provider Demographics
NPI:1073835492
Name:ROCKY MOUNTAIN TREATMENT CENTERS OF FT COLLINS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN TREATMENT CENTERS OF FT COLLINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARGHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:CAC III
Authorized Official - Phone:970-691-7556
Mailing Address - Street 1:3825 E MULBERRY ST
Mailing Address - Street 2:UNIT 5-C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-8574
Mailing Address - Country:US
Mailing Address - Phone:970-691-7556
Mailing Address - Fax:970-224-0497
Practice Address - Street 1:3825 E MULBERRY ST
Practice Address - Street 2:UNIT 5-C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-8574
Practice Address - Country:US
Practice Address - Phone:970-691-7556
Practice Address - Fax:970-224-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health