MEDICARE: ABRAZOS COMMUNITY HEALING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265279947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRAZOS COMMUNITY HEALING CENTER

Provider Business Mailing Address
First Line	:	3600 CERRILLOS RD STE 714E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 CERRILLOS RD STE 714E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2691
Country	:	US
Telephone Number	:	505-750-0558
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KEVIN MOELLER
Credential	:
Telephone Number	:	505-750-0558

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	01/14/2026

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