Provider Demographics
NPI:1386098812
Name:COMPREHENSIVE COMMUNITY BASED SERVICES
Entity type:Organization
Organization Name:COMPREHENSIVE COMMUNITY BASED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DECILLA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:303-671-6042
Mailing Address - Street 1:8668 E DOANE PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4544
Mailing Address - Country:US
Mailing Address - Phone:303-671-6042
Mailing Address - Fax:
Practice Address - Street 1:8668 E DOANE PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4544
Practice Address - Country:US
Practice Address - Phone:303-671-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04079264Medicaid