Provider Demographics
NPI:1174501860
Name:ROCKY MOUNTAIN HOMECARE, INC.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-467-0100
Mailing Address - Street 1:6340 W 56TH AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2752
Mailing Address - Country:US
Mailing Address - Phone:303-467-0100
Mailing Address - Fax:303-467-9992
Practice Address - Street 1:6340 W 56TH AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2752
Practice Address - Country:US
Practice Address - Phone:303-467-0100
Practice Address - Fax:866-861-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23286870000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002537Medicaid
CO08002537Medicaid