Provider Demographics
NPI:1386186526
Name:EASTERN COLORADO SERVICES FOR THE DEVELOPOMENTALLY DISABLED, INC.
Entity Type:Organization
Organization Name:EASTERN COLORADO SERVICES FOR THE DEVELOPOMENTALLY 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:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-1682
Mailing Address - Country:US
Mailing Address - Phone:970-522-7121
Mailing Address - Fax:870-522-1173
Practice Address - Street 1:425 GAYLE ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3920
Practice Address - Country:US
Practice Address - Phone:970-522-7121
Practice Address - Fax:870-522-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
CO05O101320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09145855Medicaid
CO26608Medicaid
CO09141888Medicaid