NPIMap

Organization Active NPI

Rocky Mountain Behavioral Health

  • Exclusive Provider Organization
  • Canon City, CO
National Provider Identifier
1407430937
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
ROCKY MOUNTAIN BEHAVIORAL HEALTH
Practice address
3239 Independence Rd
Canon City, CO 81212-9380
Phone
(719) 275-7650
Fax
(719) 275-4209
NPI assigned
May 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lois R Petersen-Kelley
Title
Business Manager
Phone
(719) 275-7650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X Primary

Addresses

Primary practice location

3239 Independence Rd
Canon City, CO 81212-9380

Mailing address

3239 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-7650

Other identifiers 1

IdentifierTypeStateIssuer
28377834MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Rocky Mountain Behavioral Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1407430937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3239 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-7650",
            "fax_number": "719-275-4209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3239 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-7650",
            "fax_number": "719-275-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "PETERSEN-KELLEY",
        "authorized_official_first_name": "LOIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "719-275-7650"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28377834",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.