NPIMap

Organization Active NPI

Southern Colorado Developmental Disabilities Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Walsenburg, CO
National Provider Identifier
1053859611
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
0507X0 Issued in CO
Legal business name
SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC
Practice address
309 E Elder St
Walsenburg, CO 81089-1601
Phone
(719) 894-6454
NPI assigned
Feb 3, 2017
Organization subpart
Yes
Parent organization
SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Duane Roy
Title
Executive Director
Phone
(719) 846-4409

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 0507X0 CO Primary
Bus 347B00000X

Addresses

Primary practice location

309 E Elder St
Walsenburg, CO 81089-1601

Mailing address

1205 Congress Dr
Trinidad, CO 81082-1283
Phone (719) 846-3391

Other identifiers 3

IdentifierTypeStateIssuer
09140070MedicaidCO
17125057MedicaidCO
09144247MedicaidCO

Other names 2

  • Bella Vista Group Home Other name
  • Las Animas County Rehabilitation Center, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Southern Colorado Developmental Disabilities Services Inc9 organizations share this tax ID, including this one
Part of
Southern Colorado Developmental Disabilities Services Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1053859611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 CONGRESS DR",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810821283",
            "telephone_number": "719-846-3391",
            "fax_number": "719-846-4543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E ELDER ST",
            "city": "WALSENBURG",
            "state": "CO",
            "postal_code": "810891601",
            "telephone_number": "719-894-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC",
        "enumeration_date": "2017-02-03",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "ROY",
        "authorized_official_first_name": "DUANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-846-4409",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": "0507X0",
            "primary": true
        },
        {
            "code": "347B00000X",
            "taxonomy_group": "",
            "desc": "Bus",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09140070",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17125057",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09144247",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bella Vista Group Home",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Las Animas County Rehabilitation Center, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walsenburg, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.