Healthcare Provider Details

I. General information

NPI: 1912209875
Provider Name (Legal Business Name): ROCKY MOUNTAIN LODGING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date: 11/29/2010
Reactivation Date: 04/22/2011

III. Provider practice location address

960 W US HIGHWAY 50
PUEBLO CO
81008-1607
US

IV. Provider business mailing address

960 W US HIGHWAY 50
PUEBLO CO
81008-1607
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-0333
  • Fax: 719-583-0332
Mailing address:
  • Phone: 719-583-0333
  • Fax: 719-583-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RITESH PATEL
Title or Position: GENERAL MANAGER
Credential:
Phone: 719-583-0333