1871613141 NPI number — DEVELOPMENTAL DISABILITIES CENTER

Table of content: (NPI 1871613141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871613141 NPI number — DEVELOPMENTAL DISABILITIES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL DISABILITIES CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IMAGINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871613141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 DIXON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80026-2790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-665-7789
Provider Business Mailing Address Fax Number:
303-665-2648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5421 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-817-4437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEVINS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
303-665-7789

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09145780 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com