Provider Demographics
NPI:1487215331
Name:COUNSELING CENTER OF THE ROCKIES, LLC
Entity Type:Organization
Organization Name:COUNSELING CENTER OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-508-4876
Mailing Address - Street 1:3489 W 72ND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5314
Mailing Address - Country:US
Mailing Address - Phone:720-508-4876
Mailing Address - Fax:720-612-4239
Practice Address - Street 1:3489 W 72ND AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5314
Practice Address - Country:US
Practice Address - Phone:720-508-4876
Practice Address - Fax:720-612-4239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNSELING CENTER OF THE ROCKIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900147874Medicaid