Healthcare Provider Details

I. General information

NPI: 1689126476
Provider Name (Legal Business Name): DEVELOPMENTAL DISABILITIES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 7TH ST
BOULDER CO
80304-4394
US

IV. Provider business mailing address

1400 DIXON AVE
LAFAYETTE CO
80026-2790
US

V. Phone/Fax

Practice location:
  • Phone: 303-413-8221
  • Fax:
Mailing address:
  • Phone: 303-665-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEVINS
Title or Position: CFO
Credential:
Phone: 303-665-7789