Healthcare Provider Details

I. General information

NPI: 1396287371
Provider Name (Legal Business Name): EASTERN COLORADO SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 2ND AVE
YUMA CO
80759-2145
US

IV. Provider business mailing address

PO BOX 1682
STERLING CO
80751-1682
US

V. Phone/Fax

Practice location:
  • Phone: 970-522-7121
  • Fax:
Mailing address:
  • Phone: 970-522-7121
  • Fax: 970-522-1173

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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: TRACI SCHRADE
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 970-522-7121