Provider Demographics
NPI:1285019430
Name:ROCKY MOUNTIAN YOUTH CLINICS
Entity type:Organization
Organization Name:ROCKY MOUNTIAN YOUTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHARENA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-450-3690
Mailing Address - Street 1:9197 GRANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4329
Mailing Address - Country:US
Mailing Address - Phone:303-450-3690
Mailing Address - Fax:303-962-1511
Practice Address - Street 1:9197 GRANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4329
Practice Address - Country:US
Practice Address - Phone:303-450-3690
Practice Address - Fax:303-962-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty