Provider Demographics
NPI:1639252638
Name:COMMONWORKS
Entity Type:Organization
Organization Name:COMMONWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-641-3827
Mailing Address - Street 1:4575 GALLEY RD
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2750
Mailing Address - Country:US
Mailing Address - Phone:719-574-6101
Mailing Address - Fax:719-574-6105
Practice Address - Street 1:1325 S COLORADO BLVD
Practice Address - Street 2:SUITE B 502
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3303
Practice Address - Country:US
Practice Address - Phone:720-214-0830
Practice Address - Fax:720-214-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60803568Medicaid