HomeMy WebLinkAbout20091220.tiffRESOLUTION
RE: APPROVE STANDARD FORMS FOR INDIVIDUAL PROVIDER CONTRACT FOR
PURPOSE OF FOSTER CARE SERVICES AND FOSTER CARE FACILITY AGREEMENT
AND ADDENDUM THERETO BETWEEN THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES AND VARIOUS PROVIDERS
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board, sitting as the Weld County Board of Social Services, has been
presented with the Forms of the Individual Provider Contract for the Purpose of Foster Care
Services and Foster Care Facility Agreement and an Addendum thereto, between the Weld County
Department of Human Services and various providers, and
WHEREAS, after review, the Board deems it advisable to approve said forms, copies of
which are attached hereto and incorporated herein by reference, and to delegate standing authority
to the Chair of the Board of County Commissioners to execute individual agreements and
addendums between the Department of Human Services and various providers.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex -officio Board of Social Services, that the forms of the Individual Provider
Contract for the Purpose of Foster Care Services and Foster Care Facility Agreement and
Addendum thereto, between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services, and various providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreements and addendums between the Department of Human Services and various
providers upon presentation.
2009-1220
// HR0080
C�a60/0
RE: APPROVE STANDARD FORMS FOR INDIVIDUAL PROVIDER CONTRACT FOR PURPOSE
OF FOSTER CARE SERVICES AND FOSTER CARE FACILITY AGREEMENT AND ADDENDUM
THERETO, BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND
VARIOUS PROVIDERS
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 27th day of May, A.D., 2009.
BOARD OF COUNTY COMMISSIONERS
W. ' D •Use , COLORADO
ATTEST:
Weld County Clerk to the Boa
BY
Deputy erk to the Board
APPROVED AS TO FORM
o/ ?/o7
y AttorWey
Date of signature
m F. Garcia, Chair
ademac/her, Pro-Tem
Sean P.Conway
I/
arbara Kirkmey
David E. Long
2009-1220
H R0080
CWS-7A (RI0-10/99)
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
1. THIS CONTRACT AND AGREEMENT, made this date, by and between
the Board of Weld County Commissioners, sitting as the Board of Social Services, on behalf of
the Weld County Department of Human Services, hereinafter called "County Department" and,
«NAME», Provider ID#uPROVIDER_ID», «MAILING_ADDRESS», «CITY_STATE_ZIP»,
hereinafter called "Provider."
2. This Contract and Agreement shall be effective from July 1, 2009 and continue in force until
June 30, 2010 or until the facility certificate is revoked or surrendered. This contract and
agreement may be renewed at any time during the term of the valid facility certificate. This
contract and agreement is in lieu of and supersedes all prior purchase contracts between the
parties hereto and relating to the services herein described.
3. The Provider holds a valid certificate/license as a Family Foster Home/Emergency Shelter Home.
Such certification standards shall be maintained during the term hereof The provider has read
and is fully familiar with the Minimum Rules and Regulations for Family Foster Homes issued by
the Colorado Department of Human Services.
4. The County Department may, but shall not be obligated to, purchase foster care services. The
County Department or any duly authorized agent may request such services to be provided to
any child at any time within the limits of the certificate and without prior notice. At such time or as
soon as possible after the acceptance of a child for services, the County Department and the
Provider shall verify foster care placement of each child in writing on the required form, which
shall become an addendum to this contract, subject to all the terms and conditions hereof.
The Provider agrees:
1. To furnish foster care services to eligible children at the established rate based on type of facility
and individual child rates negotiated between the county and the provider.
2. To safely provide the 24 -hour physical care and supervision of each child until removed or until
the agreement is renewed.
3. To accept children only with the approval of the certifying/licensing agency.
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans for children in placement, including visits with their
parents, siblings, and relatives, or transition to another foster care facility.
5. To maintain approved standards of care as set by the State Department of Human Services.
6. To keep confidential the information shared about the child and his/her family.
7. Not to accept money from parents or guardians.
8. Not to make any independent agreement with parents or guardians.
9. Not to release the child to anyone without prior authorization from the Department.
10. To allow representatives of the County Department to visit the foster home and to see the child at
any reasonable time.
1
2009-1220
CWS-7A S -7A (R10-10/99)
11. To give the County Department two weeks notice, except in an emergency, to remove a child for
placement elsewhere and to work with the County Department as requested in preparing the child
for the next placement.
12. To provide transportation to the child to enable the utilization of professional services when
necessary. The amount of transportation to be provided will be agreed upon at placement and
may be changed upon mutual agreement of the provider and the County Department, as
recorded in the Family Services Plan.
13. To report promptly to the Department:
a. Any unplanned absence of the child from provider's care.
b. Any major illness of the child.
c. Any serious injury to the child.
d. Any significant change in the child's sleeping arrangement.
e. Any contemplated change of address or change of household members.
f. Any conflict the child may have with law enforcement, school officials, or other persons in
the authority.
g. Any emergency.
h. Any pertinent discussion with parents or guardians about the child or supervising
agency.
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA
of 1990, concerning discrimination on the basis of race, color, sex, age, religion, political beliefs,
national origin, or handicap.
15. To attend core certification training prior to the placement of any child.
16. To attend on -going training as required by State Department regulations.
17. To attend Administrative Reviews for children in placement.
18. To fully comply with the Minimum Rules and Regulations for Foster Family Homes or Specialized
Group Facilities.
19. Not to enter into any subordinate subcontract hereunder.
20. To keep such records as are necessary for audit purposes by state and federal personnel. The
records shall document the type of care and the term during which care is provided for each child.
In addition, medical, educational, and progress summary records shall be maintained for each
child in accordance with Volume 7 requirements.
21. To maintain medical, dental and educational records for each child/youth and supply updated
information to the County Department.
County Department agrees:
1. To share all available information about the child, including relevant social, medical and
educational history, behavior problems, court involvement, parental, sibling and relative visitation
plans, and other specific characteristics of the child, with the provider before placement and to
share additional information when obtained.
2. To inform the provider of expectations regarding the care of the child, such as meeting medical
needs, handling special psychological needs, and separation/loss issues.
3. To arrange for a medical examination of the child before placement or within 14 days after
placement and give a copy of the completed form to the out -of -home provider.
2
CWS-7A (R10-10/99)
4. To give the provider a written record of the child's admission to the home at the time of
placement.
5. To give the provider a written procedure or authorization for obtaining medical care for the child.
6. To involve the provider in service planning for the child as part of the overall treatment team.
7. To give the provider a copy of the Family Services Plan for the child at the time of placement or
as soon as it is completed following placement.
8. To give at least two weeks notice of plans to remove a child from the facility. The two-week notice
may be waived by mutual consent to allow immediate removal of said child for placement
elsewhere, or without such waiver in the event of an emergency. An emergency is defined as any
situation in which a provider's inability to provide services threatens the health, safety or welfare
of children.
9. To pay the provider at the rates established by the State Department of Human Services or as
negotiated between the provider and the county. The rate of payment per month shall be based
on the type of facility and individual rates. Payment shall be by warrant drawn by the duly
authorized county officer.
10. To provide or arrange through statewide contracted training a minimum of twelve hours of core
certification training for family foster homes. The county department is responsible for providing
information on county specific procedures.
11. To invite the provider to Administrative Reviews for Children in placement.
12. To incorporate provider information in planning for the child.
13. To assure that the service described herein has been accomplished and a record made thereof
on a case by case basis.
14. To provide notice of hearings.
Additional Agreement regarding a Particular Child:
Please refer to the Weld County Addendum and
the child specific Needs Based Care Addendum to this agreement.
ATTEST: Weld County Clerk to the Board
By:
Deputy Clerk to the Board
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
WELD COUNTY BOARD OF SOCIAL
SERVICES, ON BEHALF OF THE WELD
COUNTY DEPARTMENT OF HUMAN
SERVICES
By:
Chair Signature
PROVIDER
«PROVIDER_NAME»
«MAILING_ADDRESS»
C ITY_STATE_ZI P»
By: By:
Director
3
DEPARTMENT OF HUMAN SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website: www.co.weld.co.us
Administration and Public Assistance (970) 352-1551
Child Support (970) 352-6933
IIMc
COLORADO
MEMORANDUM
TO: Judy Griego - Director
FROM: Lesley Cobb - Child Welfare Contract Negotiator
DATE: April 30, 2009
SUBJECT: Out -of -home providers to be submitted to the
Board of County Commissioners for Consent.
Attached please find the proposed Weld County Addendums and list of out -of -home providers that I am requesting
to be submitted to the Board of County Commissioners for their consent.
Directory:
Attachment I — RCCF/TRCCF contract and provider list
Rates are based on the State Standard rates from 2008-2009 (also known as base anchor rates). No COLA is being
recommended for the 2009-2010 fiscal year.
Attachment II — County Certified Foster Care contract and provider list
Rates are based the Needs Based Care Assessment and rate table as approved by the Board of Weld County
Commissioners. No COLA is being recommended for the 2009-2010 fiscal year.
Attachment III — Child Placement Agency contract and provider list
Rates are based on the Needs Based Care Assessment and rate table as approved by the Board of Weld County
Commissioners. No COLA is being recommended for the 2009-2010 fiscal year.
Attachment IV — Child Placement Agency Group Home/Center contract and provider list
Rates are negotiated per home/center due to highly specialized care for children who are stepping down from
TRCCF care or cannot maintain in a foster care home setting.
Attachment V — RCCF/CHRP contract and provider list
Rates are based on a negotiated rate per agency due to highly specialized care for children who are not eligible or
who are awaiting approval for CHRP.
Attachment VI - Specialized Group Homes contract and provider list
Rates are based on the approved rate structure as outlined in DHS policy/procedures manual section 2.308.5. No
COLA is being recommended for the 2009-2010 fiscal year.
Attachment VII — RCCF contract and provider list
Rates are negotiated based on the high level of needs the child requires. These providers consist of out-of-state
providers where Weld children have exhausted all Colorado resources and facilities that are considered
transition/step down programs for Therapeutic Residential Treatment Centers.
Attachment VIII — TRCCF guarantee bed contracts with Shiloh Home, Inc.
Weld County contracts with this provider to have six (6) guaranteed beds for the County's exclusive use.
Attachment XI — TRCCF guarantee bed contracts with Reflection for Youth, Inc.
Weld County contracts with this provider to have four (4) guaranteed beds for the County's exclusive use.
Attachment II
WELD COUNTY ADDENDUM
To that certain Individual Provider Contract for Purpose of Foster Care
Services and Foster Care Facility Agreement (the "Agreement") between
«NAME»
and the
Weld County Department of Human Services
for the period from July 1, 2009 through June 30, 2010.
The following provisions, made this day of , 2009, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
GENERAL PROVISIONS
1. County and Provider agree that a child specific Needs Based Care Assessment,
designated as Attachment B, shall be used to determine levels of care for each child
placed with Provider unless the child is placed in a County certified kinship foster care
home or if the child is placed in a County foster/adoption home as a pre -adoptive
placement. Kinship foster care homes and pre -adoptive placements will be reimbursed at
the County Basic Maintenance level on the Needs Based Care Rate Table, designated as
Attachment C, regardless of the child's level of need.
2. County agrees to purchase and Provider agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the Weld County Certified Foster Care Home identified as Provider
ID#«PROVIDER_ID». These services will be for children who have been deemed
eligible for social services under the statutes, rules and regulations of the State of
Colorado.
3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Department Administrator before payment will
be release to Provider.
4. Any additional costs for specialized services, which may include but are not limited to;
Co -pays, deductibles, or services not covered by Medicaid, will need to be authorized, in
writing by the Department Administrator, prior to the service being performed. Any
payment for specialized services not authorized in writing may be denied.
5. All reimbursement requests shall:
A. Be submitted in a format approved by the County. If submitted in an unapproved
format or inadequate documentation is provided, the County reserves the right to
deny payment.
B. Be submitted by the 4`h of each month following the month of service. If the
reimbursement request is not submitted within twenty-five (25) calendar days of
the month following service, it may result in forfeiture of payment.
C. Placement service reimbursement shall be paid from the date of placement up to,
but not including the day of discharge.
D. Transportation reimbursement shall be for visitation purposes only. Any other
special request for transportation reimbursement shall require prior approval by
the Service Utilization Unit Manager or the Department Administrator.
E. Clothing allowance reimbursement shall be approved and reimbursed as indicated
on the clothing allowance form accessed through the Foster Parents Database On-
line System (FID0S).
6. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Provider substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Provider until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the Provider
cannot be performed or if performed would be of no value to the Human Services.
Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
D. Recover from the Provider any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Provider, or by Human
Services as a debt to Human Services or otherwise as provided by law.
7. Provider shall promptly notify Human Services in the event in which it is a party
defendant or respondent in a case, which involves services provided under the agreement.
The Provider, within five (5) calendar days after being served with a summons,
complaint, or other pleading which has been filed in any federal or state court or
administrative agency, shall deliver copies of such document(s) to the Human Services'
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
PROVIDER AGREES:
1. To attend or participate, if requested by the Department, in staffing a child's placement
with the Utilization Review Team. Provider shall be notified by Department staff of the
date and time of the utilization review.
2. To request a staffing if considering giving notice to remove a child, except in emergency
situations. These requests shall be made through the child's caseworker and/or the
provider's Foster Care Coordinator.
3. To cooperate with any contractors hired by Weld County Department of Human Services
or Weld County Department of Human Services staff to preserve placement in the least
restrictive placement appropriate and to comply with the treatment plan of the child.
4. To schedule physical and dental examinations within 24 hours after a child is placed in
provider's care. Medical examinations need to be completed within 14 days and dental
examinations need to be completed within 8 weeks of the child being placed with
Provider. All documentation of these examinations will be placed in the foster child's
placement binder.
5. To attend all necessary school meetings and support any plan that is developed regarding
the child in order to promote educational success.
6. To report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set fourth in Section 19-3-304, C.R.S.
7. To maintain, access and review information weekly on the Foster Parents Internet
Database On-line System (FIDOS).
8. To read, be familiar with and agree to the terms and conditions as set forth in the Foster
Parent Handbook which can be accessed through FIDOS.
9. To maintain/update information in the foster child's binder. The binder will be reviewed
on a monthly basis and signed off by child's caseworker and/or the provider's Foster
Care Coordinator.
10. To maintain behavior observation notes as required by the level of care assessed for each
child.
11. Comply with all County and State certification requirements as set forth in the State
Department rules, Staff Manual Volume VII and the Weld County Department of Human
Services Policy and Procedure manual.
EXHIBITS: (Please refer to pages 4-7)
WELD COUNTY DHS
NEEDS BASED CARE ASSESSMENT
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT
• For each question below, please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following: Therapy; Medical Treatment;
Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan?
❑Basic Maint.) Less than one round trip a week
❑2) 3-4 round trips a week.
03%) 7 round trips or more
Comments:
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑1) One round trip a week ❑1%:) 2 round trips a week
❑2%) 5 round trips a week 03) 6 round trips a week
0 Basic Maint.) No participation required ❑1) Once a month ❑1%) Two times month
02) Three times a month ❑2'/) Once a week 03) Two times a week
❑3'/) Three times a week or more
Comments:
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular of
special education plan?
0 Basic Maint.) No educational requirements ❑ 1) Less than a % hour per day ❑ 1%) '/, hour a day
❑2) 1 hour a day 02 %) 1'/:-2 hours per day 03) 2%-3 hours per day
❑3'/) More that 3 hours per day
Comments:
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
D Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week O1'A) 5 to 7 hours per week
❑2) 8 to 10 hours per week 02%) 11 to 14 hours per week
❑ 3) Constant basis during awake hours 03%) Nighttime hours
Comments:
P 5. How much time is the provider required to assist the child because of impairments beyond aae appropriate needs with feedir
bathing, grooming, physical, and/or occupational therapy?
❑ Basic Maint.) 0-2 hours per week
02) 8 to 10 hours per week
03%) 21 or more hours per week
Comments:
❑ 1) 3 to 4 hours per week ❑ 1%) 5 to 7 hours per week
02%) 11 to 15 hours per week ❑3) 16 to 20 per week
A 1. How often is CPA/County case management required? (Does not include therapy)
❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention.
(i.e. mutual care placements.)
❑l) Face-to-face contact one time per month with child and minimal crisis intervention.
01%) Face-to-face contact one time per month with child and occasional crisis intervention.
02) Face-to-face contact two times per month with child and occasional crisis intervention.
02%) Face-to-face contact three times per month with child and occasional crisis intervention.
❑3) Face-to-face contact weekly with child and occasional crisis intervention.
03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive
coordination of multiple services.
**Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one
County foster child is with the same provider.
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
❑0) Not needed or provided by another source (i.e. Medicaid) DI) Less than 4 hours per month
❑2) 4-8 hours per month ❑3) 9-12 hours per month
WELD COUNTY DHS
NEEDS BASED CARE ASSESSMENT
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Rating of Conditions
(Check one box for each category)
None
Mild
Mild/
Moderate/
Hieh
2 1/2
eh
'MegAssessment
3
High/
Severe
Comments:
Areas Moderate Moderate
0
1
1 1/2
2
3 1/2
Aggression/Cruelty to
Animals
❑
❑
❑
❑
❑
❑
•
Verbal or Physical
Threatening
❑
❑
❑
❑
❑
❑
❑
Destructive of
Property/Fire Setting
❑
❑
❑
❑
❑
❑
❑
Stealing
❑
❑
❑
❑
❑•❑
Self -injurious Behavior
❑
❑
❑
❑•❑
❑
Substance Abuse
❑
❑
❑
❑
❑
❑
❑
Presence of Psychiatric
Symptoms/Conditions
❑•
O
❑
❑
Enuresis/Encopresis
❑
❑
❑
❑
❑
■
■
Runaway
❑
❑
❑
❑
❑
❑
❑
Sexual Offenses
❑
❑
❑
❑
❑
■
•
BEHAVIOR ASSESSMENT CONTINUED
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Rating of Conditions
(Check one box for each category)
Assessment Areas
None
0
Mild
Mild/
Moderate
Moderate
Moderate
/ Htgh
2 1/2
High
High/
Severe
Comments:
1
1 1/2
2
3
3 1/2
Inappropriate Sexual
Behavior
❑
❑
❑
❑
❑
❑
•
Disruptive Behavior
❑
❑
❑
❑
❑
❑
❑
Delinquent Behavior
❑
❑
❑
❑
❑
❑
❑
Depressive -like Behavior
❑
❑
❑
❑
❑
❑
■
Medical Needs
(If condition is rated "severe",
please complete the Medically
fragile NBC)
❑
❑
❑
❑
❑
❑
•
Emancipation
❑
❑
❑•❑
❑
❑
Eating Problems
O
❑
❑
❑
❑
❑
❑
Boundary Issues
❑
❑
❑
❑
❑
❑
❑
Requires Night Care
❑
❑
❑
❑•❑
❑
Education
❑
❑
❑
❑
❑
❑
■
Involvement with Child's
Family
❑
❑
❑
❑
❑
❑
❑
CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT:
(check level of need) ❑ 0 ❑ l ❑ 1'% ❑ 2 ❑ 2'/z ❑ 3 ❑ 3'/
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
LEVEL OF SERVICE
RECOMMENDED
PROVIDER RATE
Pl - PS
Level
Rate
County Basic
Maintenance
Rate
Age 0-10...$16.32/day ($496/month)
Age 11-14...$18.05/day ($549/month)
Age 15-21...$19.27/day ($586/month)
+ Respite Care $.66/day ($20/month)
1
$19.73
+$.66 Respite Care
Total Rate = ($20.39 day/$620 month)
1 1/2
$23.01
+$,66 Respite Care
Total Rate = ($23.67 day/$720 month)
2
$26.30
+$.66 Respite Care
Total Rate =($26.96 day/$820 month)
2 1/2
$29.59
+$.66 Respite Care
Total Rate = ($30.25 day/$920 month)
3
$32.88
+$,66 Respite Care
Total Rate= ($33.54day/$1020 month)
3 1/2
$36.16
+$.66 Respite Care
Total Rate = ($36.82 day/$1,120 month)
4
TRCCF Drop Down
$39.45
+$.66 Respite Care
Total Rate = ($40.11 day/$1220 month)
Assessment/Emergency
Rate
(30 day max)
$30.25 day/$920 month (Includes Respite)
Effective 7/1/2008
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Weld County Clerk to the Board
By:
Deputy Clerk to the Board
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
WELD COUNTY BOARD OF
SOCIAL SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By:
Chair Signature
PROVIDER
«NAME»
«MAILING_ADDRESS»
«CITY STATE ZIP»
By: By:
Director
24
25
26
COUNTY FC
PROVIDER NAME
PROVIDER ID
MAILING ADDRESS
CITY STATE ZIP
1
2
3
4
5
6
Armfield, Pamela
Baker, Elissa
Beasley, Travis and
Sarah
Brilla, Debbie
Brown, Scott and
Robin
Burden, Craig and
Lea
7 Caldwell, Cynthia
8
9
10
11
Carter, Jeremy and
Susan
Cordova, Freddie and
Linda
Corliss, Wade and
Loni
Cowper, Michael and
Alecia
Dickerson, Autumn
12 and
Kristian Mathisen, Jr.
13 Dietz, Bill and Wilma
14
15
16
17
18
19
20
21
22
DiGesualdo, Kenneth
Scott
Downey, John and
Donna
Erbacher, Dan and
Hal lie
Fisher, Matthew and
Claire
Fisher, Steve and
Joletta
Gerardy, Jerry and
Priscilla
Goodman, Bob and
Katie
Hamilton, Kerry and
Kate
Hebbeler, Troy and
Christina
23 Reimer, Sara
Hendrix, Samuel and
Shanaine
Hernandez, Roberto
and Margarita
Holmgren, David and
Dawn
1549727
1552821
1552607
30451
1524302
1552261
1550399
1556173
1556594
1547483
1526756
1554460
8635
1552078
1551054
1546381
1532312
1515472
1530549
1552796
1547784
1522988
1547292
1553157
1520297
PO Box 254
2613 15th Ave Ct
840 Grandview Meadows
Dr #A101
2018 20th St Rd
301 Hickory Ave
2203 A Street
936 Eichhorn Dr
Westminster
3332 W 35th St
4017 Harbor Ln
26649 CR 60 1/2
509 N Sholdt Dr
5505 WCR 38
21257 Hwy14
529 3rd St
3826 W. 8th Street
Pierce, CO 80650
Greeley, CO 80634
Longmont, CO
80503
Greeley, CO 80631
Eaton, CO 80615
Greeley, CO 80631
Erie, CO 80516
Greeley, CO 80634
Evans, CO 80620
Greeley, CO 80631
Platteville, CO
80651
Platteville, CO
80651
Ault, CO 80610
Frederick, CO
80530
Greeley CO 80634
3850 Cheyenne Dr Greeley, CO 80634
5022 W 2nd St Rd Greeley, CO 80634
1416 16th Ave
3408 Cody Ave Evans, CO 80620
8134 Louden Circle Windsor, CO 80550
1744 69th Ave Greeley, CO 80634
3610 Cactus Ave Evans, CO 80620
3000 W 19th St
6606 Tenderfoot Ave
912 Elm Ct
Greeley, CO 80631-
4535
Greeley, CO 80634
Firestone, CO
80504
Fort Lupton, CO
80621
1522699 864 Amber Court Windsor, CO 80550
COUNTY FC
PROVIDER ID
MAILING ADDRESS
CITY STATE ZIP
PROVIDER NAME
27 Hunt, Olen J and Nina
Hymel, Chad and
Tiffany
Jackson, Scott and
Andrea
Keaton, Roger (R.C.)
and Eva
Kilgore, Julius and
Pamela
32 Kniss, Kevin and Kelly
Knutson, Troy and
Stacy
Leonard, Daniel and
Julie
Lewis, David and
Connie
Loschen, Todd and
Alicia
Louvado-Gaige, Frank
and Virginia
Maronek, Dennis and
Patricia
Martinez, Joseph and
Patricia
Mauk, James and
Harriett
McCreery, James and
Tammy
McGee, Donna
28
29
30
31
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
McLaughlin, Cynthia
Mellmen, Jeffrey and
Letha
Mena, David and
Marie
Middleton, Brian and
Deborah
Montez, Joseph and
Alexis
Moore, Earl and
Patricia
Munnelly, John and
Heidi
Murrell, Nicholas and
Terri
Parker, Brian and
Beryldell
Pearson, Christina
and Christopher
Pluma, Mike and
Annette
Preston, Daniel and
Lisa
1503154
1540875
1536689
1545954
1538189
1524303
1522516
1547609
1523277
1528352
1551566
1520627
1548845
1537621
40215
1539853
1556217
1547484
1510691
1537851
1582735
1517579
1523563
1547183
1538709
1545258
35126
1548050
224 48th Ave
1257 Red Mountain Dr
425 Hickory Ln
25565 CR 47
1740 7th Ave
1545 71st Ave
6250 Stagecoach Ave
5517 Morgan Way
2904 42nd Ave
1747 68th Ave
3041 Promontory Loop
4860 Eagle Crest Blvd
9659 W 75th Ave
3620 Dilley Circle
120 Maple Ave
1649 31st Ave
10578 Barron Circle
352 Laurel Ave
2905 41st Ave
2418 W. 24th St Rd
3660 W. 25th St #1102
135 Poplar St
291 Columbus St
812 Scotch Pine Dr
3001 50th Ave
2716 E. 132nd Place
PO Box 34
611 Cornerstone Dr
Greeley, CO 80634
Longmont, CO
80501
Johnstown, CO
80534
Greeley, CO 80631
Greeley, CO 80631
Greeley, CO 80634
Firestone, CO
80504
Frederick, CO
80504-4423
Greeley, CO 80634
Greeley, CO 80634
Broomfield, CO
80023
Firestone, CO
80504
Arvada, CO 80005
Johnstown, CO
80534
Eaton, CO 80615
Greeley, CO 80634
Firestone, CO
80504
Eaton, CO 80615
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Lochbuie, CO
80603
Windsor, CO 80550
Windsor, CO 80550
Greeley, CO 80634
Thornton, CO
80241
Kersey, CO 80644
Windsor, CO 80550
COUNTY FC
PROVIDER ID
MAILING ADDRESS
CITY STATE ZIP
PROVIDER NAME
55
56
57
58
59
60
61
62
63
64
65
66
67
Purcella, Denise
Ramos, Julian
Ransome,
Christopher and Mary
Rasmussen, Dennis
and Diane
Redding, Christopher
and Sonja
Reyna, Ali and
Jessica
Ripka, Gary and
Jennifer
Risner, Larry and
Vivanco, Katherine
Ritter, Thomas and
Deborah
Rogers, Jeffrey and
Tami
Rothe, Terry and
Marilyn
Sevestre, Lewis and
Maureen
Shindle, Danny and
Andrea
68 Skeldum, William
Slaughenhaupt, Gary
and Grace
Steele, Dana and
Cassandra
Steitz, Daniel and
Natalie
Sugden, Stanley and
Lena
69
70
71
72
73
74
75
76
77
78
79
Trevino -Rivera, Irene
Van Den Elzen, Dawn
Varela, Helen
Wade, Michael and
Jodyne
Walker, Kurt and
Jennifer
White, Richard and
Melissa
Willert, Melody D and
Lee, Kimberly
1551571
37631
1552605
104555
1524128
1502220
1538429
1552270
1554009
1550689
15169
1551169
1550177
16666
1544611
1551234
1546930
1537224
1506181
44282
11418
1554152
1546248
1545830
1540372
10656 Bald Eagle Circle
2604 49th Ave
1903 24th Ave
345 Gypsum Lane
2305 42nd Ave
3304 Syrah St
2113 74th Ave
1104 N 3rd St
10136 Dearfield St
5221 Bowersox Parkway
4115 W 20th St Rd
1717 69th Ave
1606 Fairacres Rd.
5113 Saguaro Ct
30633 CR 78
324 Fossil Dr.
1701 Elder Ave
1251 51st Ave
4227 W 31st ST
7219 W 20th St Ln
1718 12th Ave
1016 Cottonwood Dr
519 Trout Creek Ct
3109 W 13th St
219 N 4th St
Firestone, CO
80504
Greeley, CO 80634
Greeley, CO 80634
Johnstown, CO
80534
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Johnstown, CO
80534
Firestone, CO
80520
Firestone, CO
80504
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80631
Johnstown, CO
80534
Eaton, CO 80615
Johnstown, CO
80534
Greeley, CO 80631
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80631
Windsor, CO 80550
Windsor, CO
80550-3194
Greeley, CO 80634
LaSalle, CO 80645
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