Healthcare Provider Details

I. General information

NPI: 1144530312
Provider Name (Legal Business Name): SUPPORT MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR STE 150
DENVER CO
80014-2637
US

IV. Provider business mailing address

4575 GALLEY RD STE 100D
COLORADO SPRINGS CO
80915-2747
US

V. Phone/Fax

Practice location:
  • Phone: 720-748-0101
  • Fax:
Mailing address:
  • Phone: 720-295-6234
  • 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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN M GRAVES
Title or Position: PRESIDENT/COO
Credential:
Phone: 719-641-3827