Provider Demographics
NPI:1821119603
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:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-574-6101
Mailing Address - Street 1:740 GUNNISON AVE
Mailing Address - Street 2:211
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3222
Mailing Address - Country:US
Mailing Address - Phone:970-245-6004
Mailing Address - Fax:
Practice Address - Street 1:740 GUNNISON AVE
Practice Address - Street 2:211
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3222
Practice Address - Country:US
Practice Address - Phone:970-245-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
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
CO09145939Medicaid