Healthcare Provider Details

I. General information

NPI: 1851973028
Provider Name (Legal Business Name): NEW MEXICO COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7841
US

IV. Provider business mailing address

7901 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7841
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-6685
  • Fax:
Mailing address:
  • Phone:
  • 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: SEAN BERGEN
Title or Position: PRESIDENT
Credential:
Phone: 505-440-6684