Provider Demographics
NPI:1326136532
Name:EL ROCKY MOUNTAIN MANAGEMENT & SERVICES, LLC
Entity Type:Organization
Organization Name:EL ROCKY MOUNTAIN MANAGEMENT & SERVICES, LLC
Other - Org Name:PATHWAY HOUSE RTC & IOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-762-6091
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:712 RENCHER
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-0582
Mailing Address - Country:US
Mailing Address - Phone:505-762-6091
Mailing Address - Fax:505-762-2815
Practice Address - Street 1:712 RENCHER ST
Practice Address - Street 2:316 WEST 7TH STREET
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-6560
Practice Address - Country:US
Practice Address - Phone:505-763-5003
Practice Address - Fax:505-762-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMM1703Medicaid
NMNM600401OtherVALUE OPTION ID #