Healthcare Provider Details

I. General information

NPI: 1780178806
Provider Name (Legal Business Name): GAINING INDEPENDENCE WITH JENEVIEVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E COLORADO AVE STE 225
COLORADO SPRINGS CO
80903
US

IV. Provider business mailing address

427 E COLORADO AVE STE 225
COLORADO SPRINGS CO
80903-3601
US

V. Phone/Fax

Practice location:
  • Phone: 719-651-1978
  • Fax:
Mailing address:
  • Phone: 719-651-1978
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. JENEVIEVE BRIAND
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential:
Phone: 719-651-1978