Healthcare Provider Details

I. General information

NPI: 1417544743
Provider Name (Legal Business Name): SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E 3RD AVE UNIT 1
DURANGO CO
81301-5049
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2288
  • Fax: 970-335-2280
Mailing address:
  • Phone: 970-335-2238
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHELLY BURKE
Title or Position: CEO
Credential:
Phone: --