Healthcare Provider Details

I. General information

NPI: 1750901260
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: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 THREE SPRINGS BLVD
DURANGO CO
81301-9033
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-403-0180
  • Fax: 970-403-0190
Mailing address:
  • Phone: 970-335-2238
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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