Healthcare Provider Details

I. General information

NPI: 1376979484
Provider Name (Legal Business Name): FIRST NATIONS COMMUNITY HEALTHSOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 TRUMAN ST NE
ALBUQUERQUE NM
87110-6443
US

IV. Provider business mailing address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-6560
  • Fax: 505-265-7045
Mailing address:
  • Phone: 505-262-6560
  • Fax: 505-265-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: LINDA SON-STONE
Title or Position: CEO
Credential: CEO
Phone: 505-262-2481