Provider Demographics
NPI:1720702137
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:000-000-0000
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:
Mailing Address - Fax:
Practice Address - Street 1:459 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:DOVE CREEK
Practice Address - State:CO
Practice Address - Zip Code:81324-4900
Practice Address - Country:US
Practice Address - Phone:970-677-2291
Practice Address - Fax:
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:2022-09-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy