Provider Demographics
NPI:1023592508
Name:COLORADO'S CHILDHOOD CANCER AND DISABILITIES CAMPS, INC.
Entity type:Organization
Organization Name:COLORADO'S CHILDHOOD CANCER AND DISABILITIES CAMPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG AND ALCOHOL PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-493-0937
Mailing Address - Street 1:530 COMMUNICATION CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1744
Mailing Address - Country:US
Mailing Address - Phone:719-493-0937
Mailing Address - Fax:
Practice Address - Street 1:51934 SOUTH HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:CO
Practice Address - Zip Code:80448-8042
Practice Address - Country:US
Practice Address - Phone:719-963-7528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health