Provider Demographics
NPI:1053509703
Name:COMMONWORKS
Entity Type:Organization
Organization Name:COMMONWORKS
Other - Org Name:SYNTHESIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-4336
Mailing Address - Street 1:3000 YOUNGFIELD ST
Mailing Address - Street 2:155
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80215-6545
Mailing Address - Country:US
Mailing Address - Phone:303-422-4336
Mailing Address - Fax:303-422-4336
Practice Address - Street 1:3000 YOUNGFIELD ST
Practice Address - Street 2:155
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80215-6545
Practice Address - Country:US
Practice Address - Phone:303-422-4336
Practice Address - Fax:303-422-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104085251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74129015Medicaid
CO104085OtherFOSTER CARE