Healthcare Provider Details

I. General information

NPI: 1346238110
Provider Name (Legal Business Name): OTERO COUNTY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WRIGHT AVE
ALAMOGORDO NM
88310-7367
US

IV. Provider business mailing address

PO BOX 1561
ALAMOGORDO NM
88311-1561
US

V. Phone/Fax

Practice location:
  • Phone: 505-437-8942
  • Fax: 505-437-8980
Mailing address:
  • Phone: 505-437-8942
  • Fax: 505-437-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number5371
License Number StateNM

VIII. Authorized Official

Name: MR. SANTIAGO RODRIGUEZ JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: LADAC
Phone: 505-437-8942