Healthcare Provider Details

I. General information

NPI: 1306365929
Provider Name (Legal Business Name): CALYX INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 12/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 LOMAS BLVD NE, STE. 101
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

PO BOX 1194
TIJERAS NM
87059-1194
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-3654
  • Fax:
Mailing address:
  • Phone: 505-652-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TRUE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-652-7065