Provider Demographics
NPI:1902592082
Name:ROARING FORK TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ROARING FORK TRANSPORTATION LLC
Other - Org Name:ROARING FORK DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-456-9965
Mailing Address - Street 1:191 PRENTICE TRL
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9827
Mailing Address - Country:US
Mailing Address - Phone:970-456-9965
Mailing Address - Fax:
Practice Address - Street 1:191 PRENTICE TRL
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-9827
Practice Address - Country:US
Practice Address - Phone:970-456-9965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle