Provider Demographics
NPI:1184792939
Name:BAPTIST HOME ASSOCIATION OF THE ROCKY MOUNTAIN INC
Entity type:Organization
Organization Name:BAPTIST HOME ASSOCIATION OF THE ROCKY MOUNTAIN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-253-1485
Mailing Address - Street 1:1535 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1657
Mailing Address - Country:US
Mailing Address - Phone:303-832-9323
Mailing Address - Fax:303-863-7636
Practice Address - Street 1:1535 PARK AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1657
Practice Address - Country:US
Practice Address - Phone:303-832-9323
Practice Address - Fax:303-863-7636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HOME ASSOCIATION OF THE ROCKY MOUNTAINS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05653779Medicaid
CO05653779Medicaid