SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER NPI 1003420555

Clinic/Center (Mental Health (Including Community Mental Health Center)) in South Fork, CO

NPI 1003420555 Organization Clinic/Center Mental Health (Including Community Menta...

About SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER

San Luis Valley Community Mental Health Center is a provider established in South Fork, Colorado specializing in clinic/center (mental health (including community mental health center)) . The NPI number of San Luis Valley Community Mental Health Center is 1003420555 and was assigned on September 2020. The practitioner's primary taxonomy code is 261QM0801X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Fernando A Martinez (Ceo)

NPI

1003420555

Provider NameSAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER
Provider Location Address20 LODGE DR SOUTH FORK, CO 81154
Provider Mailing Address8745 COUNTY ROAD 9 S ALAMOSA, CO 81101
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date09-02-2020
Last Update Date09-02-2020


Primary Taxonomy

Taxonomy Code261QM0801X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationMental Health (Including Community Mental Health Center)

Business Address

SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER
20 LODGE DR
SOUTH FORK, CO
ZIP 81154
Phone: (719) 589-3671

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Mailing Address

SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER
8745 COUNTY ROAD 9 S
ALAMOSA, CO
ZIP 81101
Phone: (719) 589-3671



Authorized Official

Authorized Official Name FERNANDO A MARTINEZ
Authorized Official TitleCEO
Authorized Official Phone(719) 589-3671

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1261Q00000XAmbulatory Health Care FacilitiesClinic/CenterNo

Taxonomy Description: a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

2261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderNo

Taxonomy Description: Not Available

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1487270179SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER
Organization
Clinic/Center (Mental Health (Including Community Mental Health Center))20 LODGE DR
SOUTH FORK, CO 81154
(719) 589-3671

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.