Provider Demographics
NPI:1558909366
Name:INTEGRATING SUPPORTS COLORADO
Entity Type:Organization
Organization Name:INTEGRATING SUPPORTS COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-313-0626
Mailing Address - Street 1:4294 GRAY FOX HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922
Mailing Address - Country:US
Mailing Address - Phone:719-313-0626
Mailing Address - Fax:720-222-5216
Practice Address - Street 1:4294 GRAY FOX HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922
Practice Address - Country:US
Practice Address - Phone:719-313-0626
Practice Address - Fax:720-222-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities