Healthcare Provider Details

I. General information

NPI: 1033796263
Provider Name (Legal Business Name): NADINE P SHAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 CRANSWOOD WAY
COLORADO SPRINGS CO
80918-6339
US

IV. Provider business mailing address

3565 CRANSWOOD WAY
COLORADO SPRINGS CO
80918-6339
US

V. Phone/Fax

Practice location:
  • Phone: 719-306-9512
  • Fax: 719-264-1899
Mailing address:
  • Phone: 719-306-9512
  • Fax: 719-264-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. NADINE P SHAW I
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-306-9512