MEDICARE: ROCKY MOUNTAIN DETOX, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1518743202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN DETOX, LLC

Provider Business Mailing Address
First Line	:	1348 PIERCE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80214-1939
Country	:	US
Telephone Number	:	480-707-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1348 PIERCE ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80214-1939
Country	:	US
Telephone Number	:	480-707-1968
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SPENCER LITMAN
Credential	:
Telephone Number	:	480-707-1968

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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