Provider Demographics
NPI:1619185832
Name:ROCKY MOUNTAIN REHAB MEDICINE
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN REHAB MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-333-4559
Mailing Address - Street 1:1633 FILLMORE ST STE 410
Mailing Address - Street 2:1633 FILLMORE ST STE 410
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1545
Mailing Address - Country:US
Mailing Address - Phone:303-333-4559
Mailing Address - Fax:303-333-0057
Practice Address - Street 1:1633 FILLMORE ST STE 410
Practice Address - Street 2:1633 FILLMORE ST STE 410
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1545
Practice Address - Country:US
Practice Address - Phone:303-333-4559
Practice Address - Fax:303-333-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1659103TR0400X
CO30858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017091Medicaid
COK8008Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER