Provider Demographics
NPI:1013462712
Name:ROCKY MOUNTAIN INDEPENDENCE LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-482-7100
Mailing Address - Street 1:1630 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2709
Mailing Address - Country:US
Mailing Address - Phone:303-482-7100
Mailing Address - Fax:
Practice Address - Street 1:1630 MILLER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2709
Practice Address - Country:US
Practice Address - Phone:303-482-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98254032Medicaid