=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366681637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST CENTER FOR INDEPENDENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2009
-----------------------------------------------------
Last Update Date | 02/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 835 E 2ND AVE SUITE 200
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-259-1672
-----------------------------------------------------
Fax | 970-259-0947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 835 E 2ND AVE SUITE 200
-----------------------------------------------------
City | DURANGO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81301-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-259-1672
-----------------------------------------------------
Fax | 970-259-0947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. IAN MICHAEL ENGLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-259-1672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------