Provider Demographics
NPI:1073246740
Name:COLORFUL BEGINNINGS SERVICES LLC
Entity type:Organization
Organization Name:COLORFUL BEGINNINGS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-209-1060
Mailing Address - Street 1:128 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2369
Mailing Address - Country:US
Mailing Address - Phone:757-209-1060
Mailing Address - Fax:757-922-8082
Practice Address - Street 1:128 INDEPENDENCE CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2369
Practice Address - Country:US
Practice Address - Phone:757-209-1060
Practice Address - Fax:757-922-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3584Medicaid