Healthcare Provider Details

I. General information

NPI: 1972623254
Provider Name (Legal Business Name): DEVELOPMENTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/15/2017
Certification Date:
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
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 Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCO

VIII. Authorized Official

Name: ROBERT W ARNOLD
Title or Position: CEO
Credential:
Phone: 719-269-2208