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609 Gold Avenue Sw Albuquerque NM 87102 | |
| (505) 246-9300 | |
| (505) 246-8905 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 609 Gold Avenue Sw, Albuquerque, New Mexico |
| Authorized Official Name and Position | Rod G Mullen (CEO) |
| Authorized Official Contact | 5207497178 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3043 Tucson AZ 85702-3043 Ph: (520) 622-6489 | 609 Gold Avenue Sw Albuquerque NM 87102 Ph: (505) 246-9300 |
| NPI Number | 1699869172 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 02/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699869172 | NPI | - | NPPES |
| 94284267667 | Other | DUN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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