Healthcare Provider Details

I. General information

NPI: 1891861837
Provider Name (Legal Business Name): ROCKY MOUNTAIN ADULT DAYCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S JASMINE ST
DENVER CO
80222-5708
US

IV. Provider business mailing address

2200 S JASMINE ST
DENVER CO
80222-5708
US

V. Phone/Fax

Practice location:
  • Phone: 303-691-2373
  • Fax: 303-691-2383
Mailing address:
  • Phone: 303-691-2373
  • Fax: 303-691-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number56884311
License Number StateCO

VIII. Authorized Official

Name: MR. MOHAMMAD ALI KHEIRANDISH PISHKENARI
Title or Position: OWNER
Credential:
Phone: 303-691-2373