Healthcare Provider Details

I. General information

NPI: 1437321189
Provider Name (Legal Business Name): PLAYDATE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 ERIN PARK DR
COLORADO SPRINGS CO
80918-3488
US

IV. Provider business mailing address

6050 ERIN PARK DR
COLORADO SPRINGS CO
80918-3488
US

V. Phone/Fax

Practice location:
  • Phone: 719-465-3989
  • Fax: 719-375-8499
Mailing address:
  • Phone: 719-465-3989
  • Fax: 719-375-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA MARIE NULK
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 719-465-3989