MEDICARE: ROCKY MOUNTAIN INTEGRITY CARE, LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1487377420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN INTEGRITY CARE, LLC

Provider Business Mailing Address
First Line	:	7428 FALCONER VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2392
Country	:	US
Telephone Number	:	719-963-1347
Fax Number	:

Provider Business Practice Location Address
First Line	:	7428 FALCONER VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2392
Country	:	US
Telephone Number	:	719-963-1347
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTONIO BENAVIDEZ
Credential	:
Telephone Number	:	719-963-1347

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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