Provider Demographics
NPI:1649672189
Name:DISABLED RESOURCE SERVICES
Entity type:Organization
Organization Name:DISABLED RESOURCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:970-449-6970
Mailing Address - Street 1:1017 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3915
Mailing Address - Country:US
Mailing Address - Phone:970-482-2700
Mailing Address - Fax:970-449-6972
Practice Address - Street 1:1017 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3915
Practice Address - Country:US
Practice Address - Phone:970-482-2700
Practice Address - Fax:970-449-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05028256Medicaid