Provider Demographics
NPI:1487420725
Name:SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-352-3429
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1328
Mailing Address - Country:US
Mailing Address - Phone:970-335-2342
Mailing Address - Fax:970-335-2438
Practice Address - Street 1:150 MERCURY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8955
Practice Address - Country:US
Practice Address - Phone:970-335-2342
Practice Address - Fax:970-335-2438
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST COLORADO MENTAL HEALTH CENTER INC DBA AXIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)