Provider Demographics
NPI:1386821742
Name:COLORADO INSTITUTE OF DEVELOPMENTAL PEDIATRICS
Entity Type:Organization
Organization Name:COLORADO INSTITUTE OF DEVELOPMENTAL PEDIATRICS
Other - Org Name:ADAM'S CAMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING & FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-563-8290
Mailing Address - Street 1:6767 S SPRUCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1283
Mailing Address - Country:US
Mailing Address - Phone:303-563-8290
Mailing Address - Fax:
Practice Address - Street 1:6767 S SPRUCE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1283
Practice Address - Country:US
Practice Address - Phone:303-563-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XP0200X, 235Z00000X
CO1544516385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty