Healthcare Provider Details

I. General information

NPI: 1558807776
Provider Name (Legal Business Name): DEVELOPMENTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 JOSIE BELLE ST
CANON CITY CO
81212-8523
US

IV. Provider business mailing address

700 S 8TH ST
CANON CITY CO
81212-4906
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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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