Healthcare Provider Details

I. General information

NPI: 1982795639
Provider Name (Legal Business Name): STATE OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

5400 GIBSON BLVD SE BOX 13
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-8978
  • Fax: 505-383-1190
Mailing address:
  • Phone: 505-841-8978
  • Fax: 505-383-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number6306
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number6306
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number6306
License Number StateNM

VIII. Authorized Official

Name: JEFF LAMURE
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-383-1122