Healthcare Provider Details

I. General information

NPI: 1396655874
Provider Name (Legal Business Name): SANDIA PURPOSE RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 ELLISON ST NE
ALBUQUERQUE NM
87109-4326
US

IV. Provider business mailing address

1313 ARCADIAN TRL NW
ALBUQUERQUE NM
87107-3404
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-2428
  • Fax:
Mailing address:
  • Phone: 505-730-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RANDY JOSEPH GUTIERREZ
Title or Position: FOUNDER
Credential: CPSW
Phone: 505-730-2428