MEDICARE: MESA DEVELOPMENTAL SERVICES

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1851954317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA DEVELOPMENTAL SERVICES

Provider Business Mailing Address
First Line	:	790 WELLINGTON AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6126
Country	:	US
Telephone Number	:	970-243-3702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 BELFORD AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-5131
Country	:	US
Telephone Number	:	970-244-5537
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHRISTOPHER BRANDON BERGQUIST
Credential	:
Telephone Number	:	970-256-8603

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	08/30/2021

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Directions to “MESA DEVELOPMENTAL SERVICES ” Practice Location

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