Provider Demographics
NPI:1184897175
Name:ROCKY MOUNTAIN AUTISM CENTER, INC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN AUTISM CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-985-1133
Mailing Address - Street 1:8600 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2757
Mailing Address - Country:US
Mailing Address - Phone:303-985-1133
Mailing Address - Fax:
Practice Address - Street 1:8600 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 800
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2757
Practice Address - Country:US
Practice Address - Phone:303-985-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00824284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83358251Medicaid
CO31401848Medicaid
CO88320570Medicaid