Provider Demographics
NPI:1295236594
Name:ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS, INC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-450-3690
Mailing Address - Street 1:9197 GRANT STREET
Mailing Address - Street 2:100
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC STREET
Practice Address - Street 2:130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5442
Practice Address - Country:US
Practice Address - Phone:303-360-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73820059Medicaid