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General NPI Number Information
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NPI Number | 1063141661
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL DYNAMICS
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 4750 S SANTA FE CIR STE 5
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City | ENGLEWOOD
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State | CO
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Zip | 80110-6493
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Country | US
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Telephone | 720-468-0896
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Fax |
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Provider Business Mailing Address
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Address Line | 4575 GALLEY RD STE 100D
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-2747
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Country | US
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Telephone | 720-295-5559
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/COO
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Name | KEVIN GRAVES
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Credential |
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Telephone | 720-295-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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