Healthcare Provider Details

I. General information

NPI: 1841665064
Provider Name (Legal Business Name): RODNEY DAN MERRITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/07/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52413 COUNTY ROAD 27
CARR CO
80612-9010
US

IV. Provider business mailing address

PO BOX 2736
LOVELAND CO
80539-2736
US

V. Phone/Fax

Practice location:
  • Phone: 970-290-9765
  • Fax: 970-461-1363
Mailing address:
  • Phone: 970-290-9165
  • Fax: 970-461-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2620-D2
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: