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General NPI Number Information
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NPI Number | 1407141260
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Entity Type | Organization
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Legal Business Name | ROCK BOTTOM RECOVERY PLACE, LLC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 6910 BANDLEY DR SUITE 135
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City | FOUNTAIN
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State | CO
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Zip | 80817-2617
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Country | US
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Telephone | 719-382-5778
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Fax | 719-390-8239
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Provider Business Mailing Address
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Address Line | 6910 BANDLEY DR SUITE 135
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City | FOUNTAIN
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State | CO
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Zip | 80817-2617
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Country | US
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Telephone | 719-382-5778
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Fax | 719-390-8239
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Authorized Official
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Title or Position | CEO, DIR. CLINICAL SERVICES
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Name | DOLORES J WALKER
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Credential | MA
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Telephone | 719-382-5778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 160701
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License Number State | CO
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