Provider Demographics
NPI:1770323214
Name:RED ROCK C & C DRIP SPA LLC
Entity type:Organization
Organization Name:RED ROCK C & C DRIP SPA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-922-3747
Mailing Address - Street 1:3687 PIONEER PARKWAY
Mailing Address - Street 2:#1
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765
Mailing Address - Country:US
Mailing Address - Phone:435-922-3747
Mailing Address - Fax:
Practice Address - Street 1:3687 PIONEER PARKWAY
Practice Address - Street 2:#1
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765
Practice Address - Country:US
Practice Address - Phone:435-922-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy