Healthcare Provider Details

I. General information

NPI: 1376992339
Provider Name (Legal Business Name): LARADON HALL SOCIETY FOR EXCEPTIONAL CHILDREN AND ADULTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 LINCOLN ST
DENVER CO
80216-2056
US

IV. Provider business mailing address

5100 LINCOLN ST
DENVER CO
80216-2056
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-2400
  • Fax:
Mailing address:
  • Phone: 303-296-2400
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: COREY KALA
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 303-296-2400