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Organization

SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DUANE ROY (EXECUTIVE DIRECTOR)
(719) 846-3391
Entity
Organization

Contact information

Practice address
415 S INDIANA AVE, TRINIDAD, CO 81082
(719) 846-4400
(719) 846-4543
Mailing address
1205 CONGRESS DR, TRINIDAD, CO 81082-1283
(719) 846-3391
(719) 846-4543

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
208100000X
Physical Medicine & Rehabilitation Physician
251B00000X
Case Management Agency
252Y00000X
Early Intervention Provider Agency
Primary
261QR0400X
Rehabilitation Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09140070
CO
Enumeration date
02/08/2017
Last updated
01/09/2020
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