Healthcare Provider Details

I. General information

NPI: 1982547972
Provider Name (Legal Business Name): SOUTHWEST ADDICTION CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 ALAMO AVE SE STE 314
ALBUQUERQUE NM
87106-3523
US

IV. Provider business mailing address

412 OLIVE AVE STE 533
HUNTINGTON BEACH CA
92648-5142
US

V. Phone/Fax

Practice location:
  • Phone: 323-670-1111
  • Fax:
Mailing address:
  • Phone: 323-670-1111
  • 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: PRISCILLA MONIQUE PORTILLO
Title or Position: CEO
Credential:
Phone: 323-670-1111