Healthcare Provider Details

I. General information

NPI: 1831606987
Provider Name (Legal Business Name): JUSTICE ACCESS SUPPORT AND SOLUTIONS FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4634
US

IV. Provider business mailing address

1608 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4634
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-8311
  • Fax: 505-288-3561
Mailing address:
  • Phone: 505-907-8311
  • Fax: 505-907-8311

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: ELIZABETH BOYCE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 505-417-2362