Provider Demographics
NPI:1619408366
Name:DD SQUARED INC
Entity Type:Organization
Organization Name:DD SQUARED INC
Other - Org Name:RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-301-1369
Mailing Address - Street 1:1657 S DE GAULLE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-6031
Mailing Address - Country:US
Mailing Address - Phone:720-301-1369
Mailing Address - Fax:
Practice Address - Street 1:1580 S SALIDA WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4210
Practice Address - Country:US
Practice Address - Phone:720-301-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities