MEDICARE: DEVELOPMENTAL DISABILITIES RESOURCE CENTER

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1861935512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL DISABILITIES RESOURCE CENTER

Provider Business Mailing Address
First Line	:	11177 W 8TH AVE
Second Line	:	SUITE 300
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-5575
Country	:	US
Telephone Number	:	303-233-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 S FLOWER ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80237
Country	:	US
Telephone Number	:	303-233-3363
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	GENA COLBERT
Credential	:	CPA, CGMA
Telephone Number	:	303-462-6509

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	07/28/2021

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