Healthcare Provider Details

I. General information

NPI: 1194861344
Provider Name (Legal Business Name): ROCKY FORD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 12TH ST
ROCKY FORD CO
81067-2128
US

IV. Provider business mailing address

900 S 12TH ST
ROCKY FORD CO
81067-2128
US

V. Phone/Fax

Practice location:
  • Phone: 719-254-3314
  • Fax:
Mailing address:
  • Phone: 719-254-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1039
License Number StateCO

VIII. Authorized Official

Name: MS. ALICE MARIE CLARK DANKS
Title or Position: VP OF FINANCE
Credential: CPA
Phone: 423-308-1866