Healthcare Provider Details

I. General information

NPI: 1467722181
Provider Name (Legal Business Name): FIRST RESORT INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7112 MINUTEMAN DR NE
ALBUQUERQUE NM
87109-5033
US

IV. Provider business mailing address

PO BOX 1659
CORRALES NM
87048-1659
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-8949
  • Fax:
Mailing address:
  • Phone: 505-417-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-2156
License Number StateNM

VIII. Authorized Official

Name: WILLIAM J ROGERS
Title or Position: OWNER
Credential: LISW
Phone: 505-417-8949