Healthcare Provider Details

I. General information

NPI: 1194265009
Provider Name (Legal Business Name): CENTER FOR PEOPLE WITH DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 RANGE ST
BOULDER CO
80301-2722
US

IV. Provider business mailing address

1675 RANGE ST
BOULDER CO
80301-2722
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-8662
  • Fax:
Mailing address:
  • Phone: 303-442-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number040306
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MARIA STEPANYAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 303-442-8662