Healthcare Provider Details

I. General information

NPI: 1508086794
Provider Name (Legal Business Name): DEVELOPMENTAL DISABILITIES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DIXON AVE
LAFAYETTE CO
80026-2790
US

IV. Provider business mailing address

1400 DIXON ST
LAFAYETTE CO
80026-2790
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-7789
  • Fax: 303-665-2648
Mailing address:
  • Phone: 303-665-7789
  • Fax: 303-665-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBIN GREY
Title or Position: CFO
Credential:
Phone: 303-641-6342