Provider Demographics
NPI:1487654562
Name:SOUTHWESTERN MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:SOUTHWESTERN MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-283-9511
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-0686
Mailing Address - Country:US
Mailing Address - Phone:507-283-9511
Mailing Address - Fax:507-283-9514
Practice Address - Street 1:117 S SPRING ST
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1916
Practice Address - Country:US
Practice Address - Phone:507-283-9511
Practice Address - Fax:507-283-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN831125261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48828SOOtherBLUE CROSS BLUE SHIELD
MN500636800Medicaid
MN534855200Medicaid
MN114833OtherUCARE
MNC07311Medicare PIN