Provider Demographics
NPI:1699181008
Name:SPORTS RECOVERY CENTER OF THE ROCKIES, LLC
Entity type:Organization
Organization Name:SPORTS RECOVERY CENTER OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-207-4066
Mailing Address - Street 1:4745 BOARDWALK DR
Mailing Address - Street 2:#C1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3768
Mailing Address - Country:US
Mailing Address - Phone:970-207-4066
Mailing Address - Fax:970-225-1392
Practice Address - Street 1:4745 BOARDWALK DR
Practice Address - Street 2:#C1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3768
Practice Address - Country:US
Practice Address - Phone:970-207-4066
Practice Address - Fax:970-225-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty