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2105 Hasler Valley Rd Gallup NM 87305 | |
| (505) 471-9856 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 2105 Hasler Valley Rd, Gallup, New Mexico |
| Authorized Official Name and Position | Elisa Schleusener (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5058475422 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2504 Camino Entrada Santa Fe NM 87507-4851 Ph: (505) 471-4985 | 2105 Hasler Valley Rd Gallup NM 87305 Ph: (505) 471-9856 |
| NPI Number | 1033716972 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 02/06/2025 |
| Certification Date | 01/30/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033716972 | NPI | - | NPPES |
| 82536716 | Medicaid | NM |
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