Provider Demographics
NPI:1891861837
Name:ROCKY MOUNTAIN ADULT DAYCARE, INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ADULT DAYCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEIRANDISH PISHKENARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-691-2373
Mailing Address - Street 1:2200 S JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5708
Mailing Address - Country:US
Mailing Address - Phone:303-691-2373
Mailing Address - Fax:303-691-2383
Practice Address - Street 1:2200 S JASMINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5708
Practice Address - Country:US
Practice Address - Phone:303-691-2373
Practice Address - Fax:303-691-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56884311261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care