Provider Demographics
NPI:1194007492
Name:ROCKY MOUNTAIN HOLDINGS LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PATIENT BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:909-915-2303
Mailing Address - Fax:402-952-2411
Practice Address - Street 1:1070 CULPEPPER DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5978
Practice Address - Country:US
Practice Address - Phone:909-915-2303
Practice Address - Fax:402-952-2411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000060023416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA59RCBLCMedicare PIN