Provider Demographics
NPI:1790286706
Name:ROSAMOND THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:ROSAMOND THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFERD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-801-8366
Mailing Address - Street 1:831 ROYAL GORGE BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-6709
Mailing Address - Country:US
Mailing Address - Phone:303-801-8366
Mailing Address - Fax:719-452-3702
Practice Address - Street 1:831 ROYAL GORGE BLVD STE 226
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-6709
Practice Address - Country:US
Practice Address - Phone:303-801-8366
Practice Address - Fax:719-452-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099238371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO233371218Medicaid