Healthcare Provider Details

I. General information

NPI: 1982249363
Provider Name (Legal Business Name): RIVER CITY RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CENTRAL AVE SW STE 12
ALBUQUERQUE NM
87102-2803
US

IV. Provider business mailing address

1202 CENTRAL AVE SW STE 12
ALBUQUERQUE NM
87102-2803
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-6502
  • Fax: 505-414-6502
Mailing address:
  • Phone: 505-414-6502
  • Fax: 505-414-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: IRENE VILLARREAL
Title or Position: OWNER
Credential: LMSW
Phone: 505-414-6502