Provider Demographics
NPI:1497398846
Name:LARADON HALL SOCIETY FOR EXCEPTIONAL CHILDREN AND ADULTS
Entity Type:Organization
Organization Name:LARADON HALL SOCIETY FOR EXCEPTIONAL CHILDREN AND ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-974-6826
Mailing Address - Street 1:5100 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2056
Mailing Address - Country:US
Mailing Address - Phone:720-974-6826
Mailing Address - Fax:
Practice Address - Street 1:5100 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2056
Practice Address - Country:US
Practice Address - Phone:720-974-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14554348Medicaid