Basic Information
| Provider Information | |||||||||
| NPI: | 1598015356 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RECOVERY SERVICES OF NEW MEXICO MDC | ||||||||
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| OtherOrganizationName: | RECOVERY SERVICES OF NEW MEXICO MDC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1528 FIVE POINTS RD SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871053179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052426919 | ||||||||
| FaxNumber: | 5052426929 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 DEPUTY DEAN MIERA DR SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871511000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058334491 | ||||||||
| FaxNumber: | 5058334492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5052426919 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | CS00214985 | NM | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.