Provider Demographics
NPI:1639224082
Name:ROCKY MOUNTAIN HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-457-0660
Mailing Address - Street 1:2812 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6371
Mailing Address - Country:US
Mailing Address - Phone:719-457-0660
Mailing Address - Fax:719-457-0766
Practice Address - Street 1:2535 BRADY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4020
Practice Address - Country:US
Practice Address - Phone:719-473-4789
Practice Address - Fax:719-457-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45084530Medicaid