Healthcare Provider Details

I. General information

NPI: 1790970879
Provider Name (Legal Business Name): THE FAMILY CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WHITEMAN DR NW
ALBUQUERQUE NM
87120-2196
US

IV. Provider business mailing address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax: 505-717-1473
Mailing address:
  • Phone: 505-717-1155
  • Fax: 505-717-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPT0088431
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: AMANDA S DAVISON
Title or Position: CEO
Credential:
Phone: 505-717-1155