Healthcare Provider Details

I. General information

NPI: 1053692293
Provider Name (Legal Business Name): ROCKY MOUNTAIN HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDUSTRIAL PARK DR
PERRY FL
32348
US

IV. Provider business mailing address

621 CARNEGIE DR STE 200
SAN BERNARDINO CA
92408-3536
US

V. Phone/Fax

Practice location:
  • Phone: 909-915-2303
  • Fax: 402-952-2411
Mailing address:
  • Phone: 909-915-2303
  • Fax: 402-952-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number0496
License Number StateFL

VIII. Authorized Official

Name: MICHAEL DENNIS ALLEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 909-915-2301