Provider Demographics
NPI:1760515241
Name:GRAND JUNCTION REGIONAL CENTER
Entity Type:Organization
Organization Name:GRAND JUNCTION REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-866-5871
Mailing Address - Street 1:2800 D RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4721
Mailing Address - Country:US
Mailing Address - Phone:970-245-2100
Mailing Address - Fax:970-255-5714
Practice Address - Street 1:2800 D RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4721
Practice Address - Country:US
Practice Address - Phone:970-245-2100
Practice Address - Fax:970-255-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0146251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09143538Medicaid