Provider Demographics
NPI:1215004015
Name:EASTER SEALS COLORADO
Entity Type:Organization
Organization Name:EASTER SEALS COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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
Mailing Address - Country:US
Mailing Address - Phone:303-233-0166
Mailing Address - Fax:303-233-1028
Practice Address - Street 1:5755 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-233-1666
Practice Address - Fax:303-233-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QA0600X
CO47762385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80554733Medicaid
CO78773075Medicaid