Provider Demographics
NPI: | 1083153886 |
---|---|
Name: | EASTER SEALS COLORADO |
Entity Type: | Organization |
Organization Name: | EASTER SEALS COLORADO |
Other - Org Name: | ROCKY MOUNTAIN VILLAGE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROMAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KRAFCZYK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 720-270-4279 |
Mailing Address - Street 1: | 5755 W ALAMEDA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEWOOD |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80226-3530 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-233-1666 |
Mailing Address - Fax: | 303-233-1028 |
Practice Address - Street 1: | 2644 ALVARADO ROAD |
Practice Address - Street 2: | |
Practice Address - City: | EMPIRE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80438 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-233-1666 |
Practice Address - Fax: | 720-278-7862 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-02-14 |
Last Update Date: | 2022-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 04X106 | 385HR2050X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |