Provider Demographics
NPI:1346646999
Name:ROCKY MOUNTAIN REHABILITATION LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN REHABILITATION LLC
Other - Org Name:ROCKY MOUNTAIN RESTORATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FARAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-320-6616
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:5 HILLCREST PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5876
Practice Address - Country:US
Practice Address - Phone:970-615-7223
Practice Address - Fax:970-615-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83828079Medicaid