| Tewa Roots Society | |
|
16a Tayeh Huu U Pueblo Of Nambe NM 87506 | |
| (505) 455-5591 | |
| Not Available |
| Full Name | Tewa Roots Society |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 16a Tayeh Huu U, Pueblo Of Nambe, New Mexico |
| Authorized Official Name and Position | Ryan Martinez (PROGRAM DIRECTOR) |
| Authorized Official Contact | 5054555591 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tewa Roots Society 15a Bay Poe Santa Fe NM 87506-2731 Ph: (505) 455-5591 | Tewa Roots Society 16a Tayeh Huu U Pueblo Of Nambe NM 87506 Ph: (505) 455-5591 |
| NPI Number | 1073110920 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 05/23/2022 |
| Certification Date | 05/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073110920 | NPI | - | NPPES |
| 39059839 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |