Healthcare Provider Details

I. General information

NPI: 1831358878
Provider Name (Legal Business Name): DEVELOPMENTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S 8TH STREET
CANON CITY CO
81212-4904
US

IV. Provider business mailing address

PO BOX 2080 700 S 8TH STREET
CANON CITY CO
81215-2080
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-1616
  • Fax: 719-275-4619
Mailing address:
  • Phone: 719-275-1616
  • Fax: 719-275-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number92875351
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: BRYANA JO MARSICANO
Title or Position: CEO
Credential: MBA
Phone: 719-269-2213