Provider Demographics
NPI:1548789332
Name:DENVER SOURCE, LLC
Entity Type:Organization
Organization Name:DENVER SOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MHA
Authorized Official - Phone:720-597-0366
Mailing Address - Street 1:1525 W PARKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2614
Mailing Address - Country:US
Mailing Address - Phone:720-291-7230
Mailing Address - Fax:
Practice Address - Street 1:1525 W PARKHILL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2614
Practice Address - Country:US
Practice Address - Phone:720-291-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENVER SOURCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No347C00000XTransportation ServicesPrivate Vehicle