NPIMap

Organization Active NPI

Southwest Colorado Mental Health Center, Inc

Doing business as Axis Health System

  • Federally Qualified Health Center (FQHC)
  • Dove Creek, CO
National Provider Identifier
1699301671
Registry record updated Oct 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Doing business as
Axis Health System
Practice address
495 W 4TH St
Dove Creek, CO 81324-4900
Phone
(970) 677-2291
NPI assigned
Mar 21, 2020
Last updated
Oct 23, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHWEST MENTAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2026

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

Authorized official

Name
Jennifer Lacov
Title
Cfo
Phone
(970) 209-1663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

495 W 4TH St
Dove Creek, CO 81324-4900

Mailing address

PO Box 1328
Durango, CO 81302-1328
Phone (970) 335-2342

Other names 2

  • AXIS HEALTH SYSTEM Doing business as
  • DOVE CREEK INTEGRATED HEALTHCARE Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326001177 CO Part B Supplier - Clinic/Group Practice 9133011802 Receives reassigned benefits from 95 practitioners
46 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gunnison, CO; Montrose, CO; Norwood, CO; Pagosa Springs, CO; Telluride, CO; Crested Butte, CO; Durango, CO; Dove Creek, CO…
O20200611002589 CO Part A Provider - Federally Qualified Health Center (FQHC) 9133011802 Practice locations: Dove Creek, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699301671. Details of each certification follow.

Federally qualified health center certification: CCN 061014

Legal name
SOUTHWEST COLORADO MENTAL HEALTH CENTER INC
Doing business as
AXIS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 9, 2020
Last certification
Jun 9, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1960 in CO
Enrollment address
495 W 4TH St
Dove Creek, CO 81324-4900

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory
Tax ID family
Pinon Mesa Guidance Cen50 organizations share this tax ID, including this one
Part of
Pinon Mesa Guidance Cen

Other organizations with this tax ID 49

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

View all 49

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janet Petty Individual W-2 Managing EmployeeRevenue Cycle Director Jan 1, 2025
Alyssa Nicholle Stock Individual W-2 Managing EmployeeInsurance Credentialing Specialist Sep 1, 2020
Shelly Burke Individual 5% Or Greater Indirect Ownership InterestChief Executive Officer Oct 11, 2000 50%
Corporate OfficerChief Executive Officer Jan 6, 2014 50%
Corporate DirectorChief Executive Officer Jan 6, 2014 50%
W-2 Managing EmployeeChief Executive Officer Oct 11, 2000
Darla Ballard Individual Contracted Managing EmployeeCredentialing Manager Jan 1, 2025

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Axis Health SystemPagosa Springs, CO, CCN 061028 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemDurango, CO, CCN 061074 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemGunnison, CO, CCN 061073 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemTelluride, CO, CCN 061082 Federally qualified health center Operational/Managerial Control Oct 7, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1584748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792713600000",
    "number": "1699301671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813021328",
            "telephone_number": "970-335-2342",
            "fax_number": "970-335-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 W 4TH ST",
            "city": "DOVE CREEK",
            "state": "CO",
            "postal_code": "813244900",
            "telephone_number": "970-677-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST MENTAL HEALTH CENTER",
        "enumeration_date": "2020-03-21",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A",
        "authorized_official_last_name": "LACOV",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-209-1663"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AXIS HEALTH SYSTEM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DOVE CREEK INTEGRATED HEALTHCARE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dove Creek, CO

Sources for this page

Verify at the official NPI Registry.