| Bethphage | |
|
920 Lobo Canyon Rd Suite 5a Grants NM 87020-2173 | |
| (505) 287-9333 | |
| (505) 287-9336 |
| Full Name | Bethphage |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 920 Lobo Canyon Rd, Grants, New Mexico |
| Authorized Official Name and Position | Dean Wilson (VP ACCOUNTING) |
| Authorized Official Contact | 4028963884 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethphage 4980 S 118th St Omaha NE 68137-2220 Ph: (402) 896-3884 | Bethphage 920 Lobo Canyon Rd Suite 5a Grants NM 87020-2173 Ph: (505) 287-9333 |
| NPI Number | 1538371521 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538371521 | NPI | - | NPPES |
| E7465 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (New Mexico) | Primary |
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