Healthcare Provider Details

I. General information

NPI: 1538796156
Provider Name (Legal Business Name): ROCKY MOUNTAIN DETOX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 PIERCE ST
LAKEWOOD CO
80214-1939
US

IV. Provider business mailing address

1336 PIERCE ST
LAKEWOOD CO
80214-1939
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-1968
  • Fax:
Mailing address:
  • Phone: 480-707-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SPENCER LITMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 480-707-1968