Healthcare Provider Details

I. General information

NPI: 1811241151
Provider Name (Legal Business Name): FIRE MOUNTAIN RESIDENTIAL TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 US HIGHWAY 36
ESTES PARK CO
80517-8834
US

IV. Provider business mailing address

5532 US HIGHWAY 36
ESTES PARK CO
80517-8834
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-3343
  • Fax: 970-577-3506
Mailing address:
  • Phone: 303-443-3343
  • Fax: 970-577-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON HUEY
Title or Position: PRESIDENT
Credential:
Phone: 303-443-3343