Basic Information
| Provider Information | |||||||||
| NPI: | 1720702137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST COLORADO MENTAL HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1328 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813021328 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 459 WEST 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | DOVE CREEK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813244900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706772291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2022 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONRAD | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 0000000000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHWEST COLORADO MENTAL HEALTH CENTER INC DBA AXIS HEALTH SYSTEM | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.