NPIMap

Organization Active NPI

Southeastern Developmental Services, Inc

Doing business as 12th Street

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Lamar, CO
National Provider Identifier
1477091833
Registry record updated Feb 6, 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
Doing business as
12th Street
Practice address
500 South 12TH Street
Lamar, CO 81052-3804
Phone
(719) 336-3244
Fax
(719) 336-3898
NPI assigned
Feb 6, 2017
Last updated
Feb 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X NU Primary

Addresses

Primary practice location

500 South 12TH Street
Lamar, CO 81052-3804

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
42125081MedicaidCO

Other names 1

  • 12th Street Doing business as

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.

Locations

500 S 12th St
Lamar, CO 81052
Phone (719) 336-3244

NPI Registry JSON

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1477091833",
    "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": "500 SOUTH 12TH 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": "2017-02-06",
        "last_updated": "2017-02-06",
        "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": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42125081",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "12th Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 6, 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.