Provider Demographics
NPI:1043047889
Name:SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SAN LUIS VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNWALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-3671
Mailing Address - Street 1:8745 COUNTY ROAD 9 S
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9610
Mailing Address - Country:US
Mailing Address - Phone:719-589-3671
Mailing Address - Fax:
Practice Address - Street 1:402 4TH AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1120
Practice Address - Country:US
Practice Address - Phone:719-589-3671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)