Provider Demographics
NPI:1447692876
Name:LA MAR CHILD PLACEMNT AGENCY
Entity type:Organization
Organization Name:LA MAR CHILD PLACEMNT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:719-391-5093
Mailing Address - Street 1:5315 HICKS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3615
Mailing Address - Country:US
Mailing Address - Phone:719-391-5093
Mailing Address - Fax:719-392-2541
Practice Address - Street 1:5315 HICKS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3615
Practice Address - Country:US
Practice Address - Phone:719-391-5093
Practice Address - Fax:719-392-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1628285320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1628285OtherLICENSE NUMBER