| Full Name | |
|---|---|
| Speciality | Clinic/center - Developmental Disabilities |
| Location | 9900 E Iliff Ave, Denver, Colorado |
| Authorized Official Name and Position | John Wetherington (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3036365796 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9900 E Iliff Ave Denver CO 80231-3462 Ph: (303) 636-5762 | 9900 E Iliff Ave Denver CO 80231 Ph: (303) 636-5600 |
| NPI Number | 1316291040 |
|---|---|
| Provider Enumeration Date | 11/02/2012 |
| Last Update Date | 01/15/2020 |
| Certification Date | 01/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316291040 | NPI | - | NPPES |
| 9000145928 | Medicaid | CO |
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