Provider Demographics
NPI:1932996733
Name:ROCKHOLD WELLNESS LLC
Entity type:Organization
Organization Name:ROCKHOLD WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-660-7365
Mailing Address - Street 1:16455 GREAT SMOKEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-9078
Mailing Address - Country:US
Mailing Address - Phone:719-660-7365
Mailing Address - Fax:
Practice Address - Street 1:685 CITADEL DR E STE 505
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5372
Practice Address - Country:US
Practice Address - Phone:719-660-7365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty