Healthcare Provider Details

I. General information

NPI: 1053324335
Provider Name (Legal Business Name): LIVING CENTERS-ROCKY MOUNTAIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RAVINIA DR STE 1250
ATLANTA GA
30346-2112
US

IV. Provider business mailing address

1 RAVINIA DR STE 1250
ATLANTA GA
30346-2112
US

V. Phone/Fax

Practice location:
  • Phone: 678-443-6772
  • Fax:
Mailing address:
  • Phone: 678-443-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-174-POPLAR
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-183-SHERIDAN
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-192-CHEYENNE
License Number StateWY

VIII. Authorized Official

Name: DEVIN EHRLICH
Title or Position: SVP
Credential:
Phone: 678-443-6772