Healthcare Provider Details

I. General information

NPI: 1184787400
Provider Name (Legal Business Name): BERNALILLO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 2ND ST NW
ALBUQUERQUE NM
87107-4009
US

IV. Provider business mailing address

PO BOX 6506
ALBUQUERQUE NM
87197-6506
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-3799
  • Fax: 505-342-3785
Mailing address:
  • Phone: 505-342-3740
  • Fax: 505-342-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3079
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3079
License Number StateNM

VIII. Authorized Official

Name: MR. THOMAS SWISSTACK
Title or Position: DIRECTOR
Credential:
Phone: 505-342-3740