Organization
ENVISION CREATIVE SUPPORT FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LU WALTON (EXECUTIVE DIRECTOR)
(970) 339-5360
Entity
Organization
Contact information
Practice address
1050 37TH ST, EVANS, CO 80620-2115
(970) 339-5360
(970) 330-2261
Mailing address
PO BOX 200069, EVANS, CO 80620-0069
(970) 339-5360
(970) 330-2261
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09139676
—
CO
05
—
09145764
—
CO
05
—
50057367
—
CO
Enumeration date
04/23/2015
Last updated
04/23/2015
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