Healthcare Provider Details

I. General information

NPI: 1710512199
Provider Name (Legal Business Name): METRO TREATMENT OF NEW MEXICO LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 COORS BLVD NW STE J&K
ALBUQUERQUE NM
87114-5025
US

IV. Provider business mailing address

2500 MAITLAND CENTER PKWY STE 250
MAITLAND FL
32751-4174
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-2400
  • Fax:
Mailing address:
  • Phone: 407-351-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MARIA JACKSON
Title or Position: CFO
Credential:
Phone: 407-351-7080