Provider Demographics
NPI:1720195142
Name:NEURO CARE OF THE ROCKIES, PC
Entity Type:Organization
Organization Name:NEURO CARE OF THE ROCKIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-686-0970
Mailing Address - Street 1:24 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-2215
Mailing Address - Country:US
Mailing Address - Phone:303-932-9404
Mailing Address - Fax:
Practice Address - Street 1:24 MOUNTAIN LAUREL DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-2215
Practice Address - Country:US
Practice Address - Phone:303-932-9404
Practice Address - Fax:303-932-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2197103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021234Medicaid
CO04021234Medicaid
COA5106Medicare ID - Type Unspecified