Healthcare Provider Details

I. General information

NPI: 1144315615
Provider Name (Legal Business Name): ALBUQUERQUE HEALTH CARE FOR THE HOMELESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 FIRST ST. NW
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

PO BOX 25445
ALBUQUERQUE NM
87125-0445
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-5197
  • Fax: 505-766-6945
Mailing address:
  • Phone: 505-766-5197
  • Fax: 505-766-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCL00007301
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number6783
License Number StateNM

VIII. Authorized Official

Name: MS. JENNIFER METZLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-766-5197