12TH STREET – NPI #1477091833
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
12TH STREET is a community based residential treatment facility located in LAMAR, CO. NPPES has assigned the NPI number 1477091833 to 12TH STREET on February 06, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “12TH STREET” is a dba name, the actual legal business name for this organization is SOUTHEASTERN DEVELOPMENTAL SERVICES, INC. The primary taxonomy selected by this provider is 320900000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities.
Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for 12TH STREET below.
NPI Profile for
SOUTHEASTERN DEVELOPMENTAL SERVICES, INC
(more than 9 years ago)
LAMAR, CO 81052-3804 Phone: (719) 336-3244 Fax: (719) 336-3898
LAMAR, CO 81052-3804 Phone: (719) 336-3244 Fax: (719) 336-3898
EXECUTIVE DIRECTOR
Phone: (719) 336-3244
Identifiers for 12TH STREET
Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.
| Description | Issuer | State | Identifier |
|---|---|---|---|
| MEDICAID | CO | 42125081 |
A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.
| Taxonomy Classification / Specialization | State | License |
|---|---|---|
| 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary) |
The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.