NPIMap

Organization Active NPI

Southern Colorado Developmental Disabilities Services, Inc

  • Early Intervention Provider Agency
  • Trinidad, CO
National Provider Identifier
1982142188
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC
Practice address
415 S Indiana Ave
Trinidad, CO 81082
Phone
(719) 846-4400
Fax
(719) 846-4543
NPI assigned
Feb 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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) 846-3391

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Case Management Agency 251B00000X
Early Intervention Provider Agency 252Y00000X Primary
Rehabilitation Clinic/Center 261QR0400X

Addresses

Primary practice location

415 S Indiana Ave
Trinidad, CO 81082

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
09140070MedicaidCO

National Provider Directory

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

Other organizations with this tax ID 8

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

Locations

415 S Indiana Ave
Trinidad, CO 81082
Phone (719) 846-4631

NPI Registry JSON

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1982142188",
    "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": "415 S INDIANA AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "81082",
            "telephone_number": "719-846-4400",
            "fax_number": "719-846-4543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO DEVELOPMENTAL DISABILITIES SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "ROY",
        "authorized_official_first_name": "DUANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-846-3391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09140070",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinidad, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; 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.