Provider Demographics
NPI:1245685916
Name:SOUTHERN COLORADO THERAPY CARE, INC.
Entity type:Organization
Organization Name:SOUTHERN COLORADO THERAPY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PALCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-240-3128
Mailing Address - Street 1:PO BOX 19962
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81019-0962
Mailing Address - Country:US
Mailing Address - Phone:719-240-3128
Mailing Address - Fax:
Practice Address - Street 1:6230 WACO MISH ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-0962
Practice Address - Country:US
Practice Address - Phone:719-240-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty