| Greater Santa Rosa Council On Alcoholism | |
|
419 S 2nd St Tucumcari NM 88401-2859 | |
| (505) 461-3572 | |
| Not Available |
| Full Name | Greater Santa Rosa Council On Alcoholism |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 419 S 2nd St, Tucumcari, New Mexico |
| Authorized Official Name and Position | Ralph L. Moya (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5054613572 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Santa Rosa Council On Alcoholism 419 S 2nd St Tucumcari NM 88401-2859 Ph: (505) 461-3572 | Greater Santa Rosa Council On Alcoholism 419 S 2nd St Tucumcari NM 88401-2859 Ph: (505) 461-3572 |
| NPI Number | 1467668814 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467668814 | NPI | - | NPPES |
| NM000217 | Other | NM | VALUE OPTIONS |
| 000A3588 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LISW1041C0700X (New Mexico) | Primary |
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