Provider Demographics
NPI:1265888176
Name:SOUTHWEST CENTER FOR INDEPENDENCE
Entity type:Organization
Organization Name:SOUTHWEST CENTER FOR INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-1672
Mailing Address - Street 1:3473 MAIN AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4010
Mailing Address - Country:US
Mailing Address - Phone:970-259-1672
Mailing Address - Fax:970-259-0947
Practice Address - Street 1:3473 MAIN AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4010
Practice Address - Country:US
Practice Address - Phone:970-259-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation