Provider Demographics
NPI:1710526504
Name:RED MOUNTAIN COLORADO, LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-515-6400
Mailing Address - Street 1:PO BOX 336100
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80633-0602
Mailing Address - Country:US
Mailing Address - Phone:970-515-6400
Mailing Address - Fax:970-978-4951
Practice Address - Street 1:5401 W 9TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4431
Practice Address - Country:US
Practice Address - Phone:970-631-6364
Practice Address - Fax:970-978-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children