Provider Demographics
NPI:1508013129
Name:DEVELOPMENTAL FX-THE DEVELOPMENTAL & FRAGILE X RESOURCE CENTER
Entity Type:Organization
Organization Name:DEVELOPMENTAL FX-THE DEVELOPMENTAL & FRAGILE X RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE & SYSTEM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:HARTMAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:303-333-8360
Mailing Address - Street 1:3615 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4976
Mailing Address - Country:US
Mailing Address - Phone:303-333-8360
Mailing Address - Fax:303-333-8380
Practice Address - Street 1:3615 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4976
Practice Address - Country:US
Practice Address - Phone:303-333-8360
Practice Address - Fax:303-333-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63670321Medicaid