Provider Demographics
NPI:1326704941
Name:SKILLS ACADEMY VOCATIONAL CENTER
Entity Type:Organization
Organization Name:SKILLS ACADEMY VOCATIONAL CENTER
Other - Org Name:SKILLS ACADEMY VOCATIONAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:VANNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-651-5102
Mailing Address - Street 1:1575 GARDEN OF THE GODS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3483
Mailing Address - Country:US
Mailing Address - Phone:719-651-5102
Mailing Address - Fax:
Practice Address - Street 1:1575 GARDEN OF THE GODS RD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3483
Practice Address - Country:US
Practice Address - Phone:719-651-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1639631237Medicaid