Provider Demographics
NPI:1326590084
Name:DEVELOPMENTAL DISABILITIES CENTER
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES CENTER
Other - Org Name:IMAGINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-665-7789
Mailing Address - Street 1:1400 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2790
Mailing Address - Country:US
Mailing Address - Phone:303-665-7789
Mailing Address - Fax:303-665-2648
Practice Address - Street 1:1806 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2235
Practice Address - Country:US
Practice Address - Phone:303-942-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services