Provider Demographics
NPI:1710649256
Name:LARADON HALL SOCIETY FOR EXCEPTIONAL CHILDREN AND ADULTS
Entity Type:Organization
Organization Name:LARADON HALL SOCIETY FOR EXCEPTIONAL CHILDREN AND ADULTS
Other - Org Name:LARADON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-296-2400
Mailing Address - Street 1:5100 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2056
Mailing Address - Country:US
Mailing Address - Phone:720-974-6804
Mailing Address - Fax:
Practice Address - Street 1:5100 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2056
Practice Address - Country:US
Practice Address - Phone:720-974-6804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48187739Medicaid