Healthcare Provider Details

I. General information

NPI: 1336507839
Provider Name (Legal Business Name): ROCKY MOUNTAIN SENIOR CARE SC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 MCINTYRE ST SUITE 201
GOLDEN CO
80403-7445
US

IV. Provider business mailing address

5920 MCINTYRE ST SUITE 201
GOLDEN CO
80403-7445
US

V. Phone/Fax

Practice location:
  • Phone: 303-949-1250
  • Fax:
Mailing address:
  • Phone: 303-949-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. LORA ELANE SHIRAR
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 303-949-1250