Healthcare Provider Details

I. General information

NPI: 1053931501
Provider Name (Legal Business Name): SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E EMPIRE ST
CORTEZ CO
81321-2802
US

IV. Provider business mailing address

PO BOX 1238
DURANGO CO
81302-1238
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-7946
  • Fax: 970-788-7635
Mailing address:
  • Phone: 970-335-2238
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHELLY BURKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: --