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General NPI Number Information
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NPI Number | 1871471391
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN CARE - SUMMIT RIDGE ASSISTED LIVING FACILITY OC LLC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1110 BIRCH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2761
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Country | US
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Telephone | 307-358-1897
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Fax |
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Provider Business Mailing Address
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Address Line | 598 W 900 S STE 220
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City | WOODS CROSS
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State | UT
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Zip | 84010-8195
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Country | US
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Telephone | 801-397-4697
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CDO
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Name | JASON GATHERUM
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Credential |
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Telephone | 801-397-4187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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