Provider Demographics
NPI:1497335806
Name:IDD SERVICES COLORADO
Entity Type:Organization
Organization Name:IDD SERVICES COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-493-1483
Mailing Address - Street 1:6764 HILLRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6316
Mailing Address - Country:US
Mailing Address - Phone:303-493-1483
Mailing Address - Fax:
Practice Address - Street 1:6764 HILLRIDGE PL
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-6316
Practice Address - Country:US
Practice Address - Phone:303-493-1483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty