Provider Demographics
NPI:1013402387
Name:SPECIAL KIDS SPECIAL FAMILIES
Entity Type:Organization
Organization Name:SPECIAL KIDS SPECIAL FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELLEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-447-8983
Mailing Address - Street 1:3830 STETSON CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4906
Mailing Address - Country:US
Mailing Address - Phone:720-988-9511
Mailing Address - Fax:719-345-1820
Practice Address - Street 1:424 W PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1525
Practice Address - Country:US
Practice Address - Phone:719-447-8983
Practice Address - Fax:719-447-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1629515507Medicaid
CO92608264Medicaid