Healthcare Provider Details

I. General information

NPI: 1871228726
Provider Name (Legal Business Name): DASTRUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W KIOWA ST
COLORADO SPRINGS CO
80905-1438
US

IV. Provider business mailing address

424 W KIOWA ST
COLORADO SPRINGS CO
80905-1438
US

V. Phone/Fax

Practice location:
  • Phone: 719-964-1766
  • Fax:
Mailing address:
  • Phone: 719-964-1766
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRANDIE HARRISON
Title or Position: CEO
Credential:
Phone: 719-964-1766