Healthcare Provider Details

I. General information

NPI: 1770009524
Provider Name (Legal Business Name): FNCH SBHC EMERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GEORGIA ST SE
ALBUQUERQUE NM
87108-3806
US

IV. Provider business mailing address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax: 505-265-7045
Mailing address:
  • Phone: 505-262-2481
  • Fax: 505-265-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA SON STONE
Title or Position: CEO
Credential:
Phone: 505-262-2481