Healthcare Provider Details

I. General information

NPI: 1316303647
Provider Name (Legal Business Name): SOUTHWEST CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-2156
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-4044
  • Fax: 505-888-9492
Mailing address:
  • Phone: 505-216-0332
  • Fax: 505-888-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPT00006225
License Number StateNM

VIII. Authorized Official

Name: MR. MICHAEL ADAMS
Title or Position: CEO
Credential:
Phone: 505-955-9454