Provider Demographics
NPI:1407141260
Name:ROCK BOTTOM RECOVERY PLACE, LLC
Entity Type:Organization
Organization Name:ROCK BOTTOM RECOVERY PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DIR. CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-382-5778
Mailing Address - Street 1:6910 BANDLEY DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2617
Mailing Address - Country:US
Mailing Address - Phone:719-382-5778
Mailing Address - Fax:719-390-8239
Practice Address - Street 1:6910 BANDLEY DR
Practice Address - Street 2:SUITE 135
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2617
Practice Address - Country:US
Practice Address - Phone:719-382-5778
Practice Address - Fax:719-390-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160701261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4306OtherLICENSED PROFESSIONAL COUNSELOR
CO507105OtherNAADAC MASTER ADDICTION COUNSELOR