Provider Demographics
| NPI: | 1134284136 |
|---|---|
| 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: | 617 S 10TH AVE |
| Mailing Address - Street 2: | P. O. BOX 1682 |
| Mailing Address - City: | STERLING |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 80751-3426 |
| 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: | 2006-12-27 |
| Last Update Date: | 2017-02-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 171WH0202X | Other Service Providers | Contractor | Home Modifications | Group - Multi-Specialty |
| No | 171WV0202X | Other Service Providers | Contractor | Vehicle Modifications | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Multi-Specialty |
| No | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Multi-Specialty | |
| No | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CO | 26454726 | Medicaid | |
| CO | 64155048 | Medicaid | |
| CO | 09141870 | Medicaid | |
| CO | 09141888 | Medicaid | |
| CO | 16155050 | Medicaid | |
| CO | 51155061 | Medicaid | |
| CO | 13155041 | Medicaid | |
| CO | 14155079 | Medicaid | |
| CO | 46135057 | Medicaid | |
| CO | 52135071 | Medicaid | |
| CO | 57125058 | Medicaid | |
| CO | 62155041 | Medicaid | |
| CO | 09139585 | Medicaid | |
| CO | 09140732 | Medicaid | |
| CO | 09139767 | Medicaid | |
| CO | 09147091 | Medicaid | |
| CO | 63135035 | Medicaid | |
| CO | 76708560 | Medicaid | |
| CO | 09145855 | Medicaid | |
| CO | 46135073 | Medicaid |
