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NPI Code Detail

MEDICARE: CENTRO SAVILA LLC

MEDICARE: CENTRO SAVILA LLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1801159884
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRO SAVILA LLC
Provider Business Mailing Address
First Line : 1317 ISLETA BLVD SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-4035
Country : US
Telephone Number : 505-312-7296
Fax Number :
Provider Business Practice Location Address
First Line : 1317 ISLETA BLVD SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-4035
Country : US
Telephone Number : 505-312-7296
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. WILLIAM G WAGNER
Credential : PHD, LISW
Telephone Number : 505-604-1640
Provider Enumeration Date : 06/24/2012
Last Update Date : 06/24/2012

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Directions to “CENTRO SAVILA LLC ” Practice Location

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