Healthcare Provider Details

I. General information

NPI: 1659945236
Provider Name (Legal Business Name): SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 COUNTY ROAD 9 S
ALAMOSA CO
81101-9610
US

IV. Provider business mailing address

8745 COUNTY ROAD 9 S
ALAMOSA CO
81101-9610
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-3671
  • Fax:
Mailing address:
  • Phone: 719-589-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ROMERO
Title or Position: CEO
Credential:
Phone: 719-589-3671