Provider Demographics
NPI:1053432385
Name:DEVELOPMENTAL DISABILITIES RESOURCE CNETER
Entity type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES RESOURCE CNETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:303-462-6511
Mailing Address - Street 1:11177 W 8TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5520
Mailing Address - Country:US
Mailing Address - Phone:303-233-2363
Mailing Address - Fax:303-233-0103
Practice Address - Street 1:11177 W 8TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5520
Practice Address - Country:US
Practice Address - Phone:303-233-2363
Practice Address - Fax:303-233-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09143470Medicaid