Healthcare Provider Details

I. General information

NPI: 1386266914
Provider Name (Legal Business Name): OUR JOURNEY DAY PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 W LAKE DR
LITTLETON CO
80123-8607
US

IV. Provider business mailing address

8981 W LAKE DR
LITTLETON CO
80123-8607
US

V. Phone/Fax

Practice location:
  • Phone: 303-717-5150
  • Fax:
Mailing address:
  • Phone: 303-717-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN O'DELL
Title or Position: DIRECTOR
Credential:
Phone: 303-717-5150