SOUTHEASTERN DEVELOPMENTAL SERVICES INC NPI 1477091833

NPI Information

NPI: 1477091833
Provider Name: SOUTHEASTERN DEVELOPMENTAL SERVICES, INC

Doing Business As: 12TH STREET

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
500 SOUTH 12TH STREET
LAMAR, CO
ZIP 81052
Phone: (719) 336-3244
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SOUTHEASTERN DEVELOPMENTAL SERVICES, INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Lamar, 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. SOUTHEASTERN DEVELOPMENTAL SERVICES, INC NPI is 1477091833. The provider is registered as an organization entity type.
The provider Is Doing Business As 12th Street.

The provider's business location address is:

500 SOUTH 12TH STREET
LAMAR, CO
ZIP 81052-804
Phone: (719) 336-3244
Fax: (719) 336-3898

The provider's authorized official is Kimberly Engsberg .
The authorized official title is Executive Director and has the following contact phone number (719) 336-3244.

The enumeration date for this NPI number is 2/6/2017 and was last updated on 2/6/2017.

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	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				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	42125081	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: 11/14/2023

NPI Synchronization or Removal

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