Provider Demographics
NPI:1194265009
Name:CENTER FOR PEOPLE WITH DISABILITIES
Entity type:Organization
Organization Name:CENTER FOR PEOPLE WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-8662
Mailing Address - Street 1:1675 RANGE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2722
Mailing Address - Country:US
Mailing Address - Phone:303-442-8662
Mailing Address - Fax:
Practice Address - Street 1:1675 RANGE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2722
Practice Address - Country:US
Practice Address - Phone:303-442-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 175T00000X, 253Z00000X, 261QA0600X, 376J00000X
CO040306251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05765003Medicaid
CO06-7065Medicare PIN