NPIMap

Organization Active NPI

Mesa Developmental Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Grand Junction, CO
National Provider Identifier
1083177315
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
MESA DEVELOPMENTAL SERVICES
Practice address
1444 N 23Rd St
Grand Junction, CO 81501-6546
Phone
(970) 254-9378
Fax
(970) 255-6462
NPI assigned
Apr 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Brandon Bergquist, AO
Title
Cfo
Phone
(970) 256-8603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

1444 N 23Rd St
Grand Junction, CO 81501-6546

Mailing address

790 Wellington Ave
Grand Junction, CO 81501-6126
Phone (970) 256-8637

Other identifiers 1

IdentifierTypeStateIssuer
76135098MedicaidCO

Other names 1

  • 1444 N. 23rd St Other name

National Provider Directory

National Provider Directory
Tax ID family
Mesa Developmental Services23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

790 Wellington Ave
Grand Junction, CO 81501
Phone (970) 243-3702

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1083177315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 WELLINGTON AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815016126",
            "telephone_number": "970-256-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 N 23RD ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815016546",
            "telephone_number": "970-254-9378",
            "fax_number": "970-255-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-12",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "BERGQUIST",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-256-8603",
        "authorized_official_credential": "AO"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76135098",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1444 N. 23rd St",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "1444 N. 23rd St",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.