Provider Demographics
NPI:1568829067
Name:S E DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:S E DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-3244
Mailing Address - Street 1:P.O. BOX 328
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3804
Mailing Address - Country:US
Mailing Address - Phone:719-336-3244
Mailing Address - Fax:719-336-3898
Practice Address - Street 1:1111 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3804
Practice Address - Country:US
Practice Address - Phone:719-336-3244
Practice Address - Fax:719-336-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23284269Medicaid