Organization
COMMONWORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN M GRAVES (PRESIDENT)
(719) 641-3827
Entity
Organization
Contact information
Practice address
1325 S COLORADO BLVD, SUITE B 502, DENVER, CO 80222-3303
(720) 214-0830
(720) 214-0835
Mailing address
4575 GALLEY RD, SUITE 400A, COLORADO SPRINGS, CO 80915-2750
(719) 574-6101
(719) 574-6105
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60803568
—
CO
Enumeration date
10/23/2006
Last updated
08/22/2020
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