MEDICARE: ROCKY MOUNTAIN KIDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1306479407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN KIDS

Provider Business Mailing Address
First Line	:	2210 E LA SALLE ST # 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2303
Country	:	US
Telephone Number	:	719-330-7244
Fax Number	:	719-635-3601

Provider Business Practice Location Address
First Line	:	3101 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3120
Country	:	US
Telephone Number	:	719-330-7244
Fax Number	:	719-635-3601

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	FELICE LIQUORI
Credential	:
Telephone Number	:	719-330-7244

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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