Organization
SOUTHEASTERN DEVELOPMENTAL SERVICES, INC
Active
Other names
14th Street
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ENGSBERG (EXECUTIVE DIRECTOR)
(719) 336-3244
Entity
Organization
Contact information
Practice address
1607 S 14TH STREET, LAMAR, CO 81052-3804
(719) 336-3244
(719) 336-3898
Mailing address
P.O. BOX 328, LAMAR, CO 81052-3804
(719) 336-3244
(719) 336-3898
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34125043
—
CO
Enumeration date
02/06/2017
Last updated
02/06/2017
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