MEDICARE: SPECIAL KIDS SPECIAL FAMILIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1629515507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL KIDS SPECIAL FAMILIES

Provider Business Mailing Address
First Line	:	1915 AEROTECH DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4222
Country	:	US
Telephone Number	:	719-447-8983
Fax Number	:	719-447-9482

Provider Business Practice Location Address
First Line	:	4795 GRANBY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3131
Country	:	US
Telephone Number	:	719-447-8983
Fax Number	:	719-447-9482

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LINDA K ELLEGARD
Credential	:
Telephone Number	:	719-447-8983

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	10/07/2021

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Directions to “SPECIAL KIDS SPECIAL FAMILIES ” Practice Location

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