| State Of The Heart Recovery Inc. | |
|
203 California St Ne Albuquerque NM 87108-1802 | |
| (505) 688-1228 | |
| Not Available |
| Full Name | State Of The Heart Recovery Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 203 California St Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Paul Thomas Chavez (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5056881228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of The Heart Recovery Inc. 203 California St Ne Albuquerque NM 87108-1802 Ph: () - | State Of The Heart Recovery Inc. 203 California St Ne Albuquerque NM 87108-1802 Ph: (505) 688-1228 |
| NPI Number | 1871137042 |
|---|---|
| Provider Enumeration Date | 10/31/2019 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 0244641058 |
|---|---|
| Medicare Enrollment ID | O20201228001185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871137042 | NPI | - | NPPES |
| 73230545 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | David M Melamed |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1154652295 PECOS PAC ID: 3375536824 Enrollment ID: I20080425000068 |
| Provider Name | Diane C Clawson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831148881 PECOS PAC ID: 4981677820 Enrollment ID: I20090130000577 |
| Provider Name | Julia Camacho |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326525395 PECOS PAC ID: 9739567686 Enrollment ID: I20220604000386 |
| Provider Name | Richard J Levine |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1699052985 PECOS PAC ID: 7315348810 Enrollment ID: I20220706001914 |
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