Provider Demographics
NPI:1700147410
Name:ROCKY MOUNTAIN HOSPICE LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:720-457-1050
Mailing Address - Street 1:3525 S TAMARAC DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1419
Mailing Address - Country:US
Mailing Address - Phone:720-457-1050
Mailing Address - Fax:303-504-9082
Practice Address - Street 1:3525 S TAMARAC DR
Practice Address - Street 2:SUITE 360
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1419
Practice Address - Country:US
Practice Address - Phone:720-457-1050
Practice Address - Fax:303-504-9082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLSTAFF HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-30
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22007Medicare UPIN