12Th Street
LBN: Southeastern Developmental Services, Inc
12Th Street is an health care organization with primary practice located at 500 South 12Th Street , Lamar CO 81052-3804. The organization recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty.
Southeastern Developmental Services, Inc can be contacted via phone (719) 336-3244, or through Engsberg, Kimberly via phone (719) 336-3244.
Contact Information
Primary practice address
500 South 12Th Street
Lamar CO 81052-3804
Phone: (719) 336-3244
Fax: (719) 336-3898
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320900000X |
Profile Details
| NPI number | 1477091833 |
|---|---|
| LBN Legal business name | Southeastern Developmental Services, Inc |
| DBA Doing business as | 12Th Street |
| Authorized official | Engsberg, Kimberly |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 6th, 2017 |
| Last updated | Feb 6th, 2017 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477091833 | NPPES |
| Colorado | MEDICAID | 42125081 |
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