NPIMap

Organization Active NPI

Southeastern Developmental Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Lamar, CO
National Provider Identifier
1437377082
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
SOUTHEASTERN DEVELOPMENTAL SERVICES, INC
Practice address
1111 South 4TH Street
Lamar, CO 81052-3804
Phone
(719) 336-3244
Fax
(719) 336-3898
NPI assigned
Apr 20, 2007
Last updated
Jan 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

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

Authorized official

Name
Kimberly Engsberg
Title
Executive Director
Phone
(719) 336-3244

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X NU
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X CO Primary
Homemaker 376J00000X NU

Addresses

Primary practice location

1111 South 4TH Street
Lamar, CO 81052-3804

Mailing address

P.O. Box 328
Lamar, CO 81052-3804
Phone (719) 336-3244

Other identifiers 1

IdentifierTypeStateIssuer
09141409MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
S E Developmental Services Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1437377082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 328",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523804",
            "telephone_number": "719-336-3244",
            "fax_number": "719-336-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SOUTH 4TH STREET",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523804",
            "telephone_number": "719-336-3244",
            "fax_number": "719-336-3898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN DEVELOPMENTAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "ENGSBERG",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-336-3244"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09141409",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lamar, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; 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.