Provider Demographics
NPI:1598992885
Name:LUCAS INC
Entity Type:Organization
Organization Name:LUCAS INC
Other - Org Name:PIKES PEAK RESPITE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SEEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-659-6344
Mailing Address - Street 1:5 PINE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4239
Mailing Address - Country:US
Mailing Address - Phone:719-659-6344
Mailing Address - Fax:720-836-4184
Practice Address - Street 1:5 PINE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-659-6344
Practice Address - Fax:720-836-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 385H00000X, 385HR2060X, 385HR2065X
CO376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid