Provider Demographics
NPI:1851683205
Name:ROCKY MOUNTAIN HOLDINGS LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:909-915-2303
Mailing Address - Fax:402-952-2411
Practice Address - Street 1:6450 POWELL RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4258
Practice Address - Country:US
Practice Address - Phone:909-915-2303
Practice Address - Fax:402-952-2411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HILDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL04963416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3871Medicare PIN