Organization
DEVELOPMENTAL DISABILITIES CENTER
Active
Other names
Imagine
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN NEVINS (CFO)
(303) 665-7789
Entity
Organization
Contact information
Practice address
4500 7TH ST, BOULDER, CO 80304-4394
(303) 413-8221
Mailing address
1400 DIXON AVE, LAFAYETTE, CO 80026-2790
(303) 665-7789
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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