Organization
INDIVIDUAL DYNAMICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN GRAVES (PRESIDENT/COO)
(720) 295-5559
Entity
Organization
Contact information
Practice address
4750 S SANTA FE CIR STE 5, ENGLEWOOD, CO 80110-6493
(720) 468-0896
Mailing address
4575 GALLEY RD STE 100D, COLORADO SPRINGS, CO 80915-2747
(720) 295-5559
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19883587
—
CO
Enumeration date
06/08/2022
Last updated
06/08/2022
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