Provider Demographics
NPI:1366977563
Name:ROCKY MOUNTAIN INDEPENDENT LIVING, INC.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN INDEPENDENT LIVING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-237-5747
Mailing Address - Street 1:2850 MCCLELLAND DR
Mailing Address - Street 2:3000-K
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2586
Mailing Address - Country:US
Mailing Address - Phone:970-237-5747
Mailing Address - Fax:970-237-6726
Practice Address - Street 1:2850 MCCLELLAND DR
Practice Address - Street 2:3000-K
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2586
Practice Address - Country:US
Practice Address - Phone:970-237-5747
Practice Address - Fax:970-237-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04V719253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care