Healthcare Provider Details

I. General information

NPI: 1639631237
Provider Name (Legal Business Name): VAN NESS DAY PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 GARDEN OF THE GODS RD STE 200
COLORADO SPRINGS CO
80907-3483
US

IV. Provider business mailing address

1575 GARDEN OF THE GODS RD STE 200
COLORADO SPRINGS CO
80907-3483
US

V. Phone/Fax

Practice location:
  • Phone: 719-651-5102
  • Fax:
Mailing address:
  • Phone: 719-651-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RANDEE VAN NESS
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 719-651-5102