Organization
CONNECTING WITH COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BYLA EISENSTEIN (EXECUTIVE DIRECTOR)
(719) 634-3121
Entity
Organization
Contact information
Practice address
895 COLUMBINE AVE, COLORADO SPRINGS, CO 80904-2782
(719) 634-3121
Mailing address
895 COLUMBINE AVE, COLORADO SPRINGS, CO 80904-2782
(719) 634-3121
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
O4C449
CO
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
O4C449
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86688383
—
CO
Enumeration date
12/18/2009
Last updated
10/20/2016
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