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General NPI Number Information
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NPI Number | 1003287723
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN STATES RECOVERY
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 7311 VILLAGE SQUARE DR 1712
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City | CASTLE PINES
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State | CO
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Zip | 80108-9373
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Country | US
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Telephone | 303-718-3039
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Fax |
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Provider Business Mailing Address
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Address Line | 7311 VILLAGE SQUARE DR 1712
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City | CASTLE PINES
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State | CO
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Zip | 80108-9373
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Country | US
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Telephone | 303-718-3039
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD BLAKE WILSON
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Credential |
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Telephone | 303-718-3039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 20151586798
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License Number State | CO
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