Provider Demographics
NPI:1588107247
Name:SPLENDOR DEVELOPMENTAL SERVICES LLC
Entity type:Organization
Organization Name:SPLENDOR DEVELOPMENTAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DANIELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-319-5098
Mailing Address - Street 1:405 PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4490
Mailing Address - Country:US
Mailing Address - Phone:970-319-5098
Mailing Address - Fax:970-947-8488
Practice Address - Street 1:405 PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4490
Practice Address - Country:US
Practice Address - Phone:970-319-5098
Practice Address - Fax:970-947-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142182Medicaid
CO34534776Medicaid