Provider Demographics
NPI:1558807776
Name:DEVELOPMENTAL OPPORTUNITIES
Entity type:Organization
Organization Name:DEVELOPMENTAL OPPORTUNITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MARSICANO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:719-269-2213
Mailing Address - Street 1:700 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4906
Mailing Address - Country:US
Mailing Address - Phone:719-275-1616
Mailing Address - Fax:719-275-4619
Practice Address - Street 1:1071 JOSIE BELLE ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8523
Practice Address - Country:US
Practice Address - Phone:719-275-1616
Practice Address - Fax:719-275-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59125071Medicaid