Healthcare Provider Details

I. General information

NPI: 1376754556
Provider Name (Legal Business Name): RECOVERY BASED SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE SUITE 228
ALBUQUERQUE NM
87110-1600
US

IV. Provider business mailing address

49 LITTLE CLOUD RD
MORIARTY NM
87035-5200
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-6003
  • Fax: 505-889-4598
Mailing address:
  • Phone: 505-832-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0103721
License Number StateNM

VIII. Authorized Official

Name: MS. NORMA JEAN FARIES
Title or Position: EXECUTIVE DIRECTOR
Credential: LADAC
Phone: 505-830-6003