Provider Demographics
NPI:1104203264
Name:EASTERN COLORADO SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.
Entity Type:Organization
Organization Name:EASTERN COLORADO SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-522-7121
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-1682
Mailing Address - Country:US
Mailing Address - Phone:970-522-7121
Mailing Address - Fax:970-522-1173
Practice Address - Street 1:617 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3426
Practice Address - Country:US
Practice Address - Phone:970-522-7121
Practice Address - Fax:970-522-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No333300000XSuppliersEmergency Response System CompaniesGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09139585Medicaid
CO09147091Medicaid
CO76708560Medicaid
CO09145855Medicaid
CO26454726Medicaid