SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES INC NPI 1598203713

NPI Information

NPI: 1598203713
Provider Name: SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC

Other Name: MADISON GROUP HOME

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
305 MADISON ST
TRINIDAD, CO
ZIP 81082
Phone: (719) 846-3391
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SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Trinidad, CO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC NPI is 1598203713. The provider is registered as an organization entity type.
The provider Other Name Is Madison Group Home.

The provider's business location address is:

305 MADISON ST
TRINIDAD, CO
ZIP 81082-736
Phone: (719) 846-3391

The provider's authorized official is Duane Roy .
The authorized official title is Executive Director and has the following contact phone number (719) 846-4409.

The enumeration date for this NPI number is 2/8/2017 and was last updated on 10/23/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	251C00000X	Day Training, Developmentally Disabled Services			No
2	332B00000X	Durable Medical Equipment & Medical Supplies			No
3	347B00000X	Bus			No
4	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	050709	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	09140070	MEDICAID	COLORADO
2	09144247	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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