06D2081426 CLIA NUMBER - SOUTHEAST MENTAL HEALTH SERVICES SEMHS

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Laboratory Demographics

CLIA Number: 06D2081426

Facility Name: SOUTHEAST MENTAL HEALTH SERVICES SEMHS

Facility Address:
903 S 12TH ST
ROCKY FORD, CO
ZIP 81067
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Facility Phone Number: 719 384-5446

Facility Type: Other - MENTAL HEALTH

Certificate Type: Waiver

NPI Number: 1407497290

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2081426
LAB Type	Other - MENTAL HEALTH
Facility Name	SOUTHEAST MENTAL HEALTH SERVICES SEMHS
Street	903 S 12TH ST
City	ROCKY FORD
State	CO
ZIP	81067
Phone	719 384-5446
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024