Provider Demographics
NPI:1710007414
Name:ROACH, JOANN (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 GOLDENEYE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9237
Mailing Address - Country:US
Mailing Address - Phone:970-587-5311
Mailing Address - Fax:
Practice Address - Street 1:1051 S PRATT PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6630
Practice Address - Country:US
Practice Address - Phone:303-678-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator