Healthcare Provider Details

I. General information

NPI: 1225340706
Provider Name (Legal Business Name): ROCKY MOUNTAIN TREATMENT CENTERS, BOULDER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 RIVERBEND RD
BOULDER CO
80301-2619
US

IV. Provider business mailing address

3825 E MULBERRY ST UNIT 5-C
FORT COLLINS CO
80524-8574
US

V. Phone/Fax

Practice location:
  • Phone: 303-960-4020
  • Fax: 970-224-0497
Mailing address:
  • Phone: 970-691-7556
  • Fax: 970-224-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WESLEY L MARGHEIM
Title or Position: PROGRAM ADMINISTRATOR
Credential: CAC III
Phone: 970-691-7556