Basic Information
| Provider Information | |||||||||
| NPI: | 1710512199 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO TREATMENT OF NEW MEXICO LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MAITLAND CENTER PKWY STE 250 | ||||||||
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| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327514174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073517080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9421 COORS BLVD NW STE J&K | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871145025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054452400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2020 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4073517080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.