Provider Demographics
NPI:1336558238
Name:ROCKY MOUNTAIN HOLDINGS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOLDINGS, LLC
Other - Org Name:LIFENET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:909-915-2304
Mailing Address - Fax:402-952-2427
Practice Address - Street 1:3689 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446
Practice Address - Country:US
Practice Address - Phone:850-482-5861
Practice Address - Fax:850-482-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05753416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL420021712Medicaid
FLE3871Medicare UPIN