Organization
DEVELOPMENTAL DISABILITIES CENTER
Active
Other names
IMAGINE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN B NEVINS II (CFO)
(303) 665-7789
Entity
Organization
Contact information
Practice address
1400 DIXON ST, LAFAYETTE, CO 80026-2790
(303) 665-7789
(303) 665-2648
Mailing address
1400 DIXON ST, LAFAYETTE, CO 80026-2790
(303) 665-7789
(303) 665-2648
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
251B00000X
Case Management Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09147240
—
CO
Enumeration date
03/29/2007
Last updated
02/14/2017
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