Healthcare Provider Details

I. General information

NPI: 1144386830
Provider Name (Legal Business Name): WESTERN CLINICAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1508
US

IV. Provider business mailing address

209 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1508
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1538
  • Fax: 505-243-5342
Mailing address:
  • Phone: 505-262-1538
  • Fax: 505-243-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberRW0336001
License Number StateNM

VIII. Authorized Official

Name: RICK TERZICK
Title or Position: CLINIC DIRECTOR
Credential: MA
Phone: 505-262-1538