Provider Demographics
NPI:1376085324
Name:SHYANNE RICHARDSON MSW
Entity Type:Organization
Organization Name:SHYANNE RICHARDSON MSW
Other - Org Name:THE SIDEWALK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:303-931-0932
Mailing Address - Street 1:895 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5724
Mailing Address - Country:US
Mailing Address - Phone:303-931-0932
Mailing Address - Fax:
Practice Address - Street 1:895 LEWIS DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5724
Practice Address - Country:US
Practice Address - Phone:303-931-0932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16738578Medicaid