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NPI Code Detail

MEDICARE: SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC

MEDICARE: SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1932192598
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Provider Business Mailing Address
First Line : PO BOX 1328
Second Line :
City : DURANGO
State : CO
Zip : 81302-1328
Country : US
Telephone Number : 970-335-2238
Fax Number : 970-335-2438
Provider Business Practice Location Address
First Line : 150 MERCURY VILLAGE DR
Second Line :
City : DURANGO
State : CO
Zip : 81301-8955
Country : US
Telephone Number : 970-335-2342
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : SHELLY BURKE
Credential :
Telephone Number : --
Provider Enumeration Date : 08/29/2005
Last Update Date : 02/28/2024

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