Healthcare Provider Details

I. General information

NPI: 1225407752
Provider Name (Legal Business Name): ST. MARTIN'S HOSPITALITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

IV. Provider business mailing address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax: 505-248-1351
Mailing address:
  • Phone: 505-764-8231
  • Fax: 505-248-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3130
License Number StateNM

VIII. Authorized Official

Name: NEVIN MARQUEZ
Title or Position: BH DIRECTOR
Credential:
Phone: 505-764-8231