Provider Demographics
NPI:1194861344
Name:ROCKY FORD HEALTHCARE LLC
Entity Type:Organization
Organization Name:ROCKY FORD HEALTHCARE LLC
Other - Org Name:PIONEER HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-308-1866
Mailing Address - Street 1:900 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-2128
Mailing Address - Country:US
Mailing Address - Phone:719-254-3314
Mailing Address - Fax:
Practice Address - Street 1:900 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-2128
Practice Address - Country:US
Practice Address - Phone:719-254-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1039314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-5235Medicare Oscar/Certification