Healthcare Provider Details

I. General information

NPI: 1992373310
Provider Name (Legal Business Name): INTERACTION RESOURCE D.D.D. C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 S INDEPENDENCE ST
LAKEWOOD CO
80235-1205
US

IV. Provider business mailing address

1639 LAWRENCE 2140
SARCOXIE MO
64862-8238
US

V. Phone/Fax

Practice location:
  • Phone: 720-291-3332
  • Fax:
Mailing address:
  • Phone:
  • 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROL A COFFEY
Title or Position: OWNER
Credential:
Phone: 720-291-3332