Healthcare Provider Details

I. General information

NPI: 1427274877
Provider Name (Legal Business Name): ALBUQUERQUE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/13/2008
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

713 MCKNIGHT AVE NW
ALBUQUERQUE NM
87102-1238
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 Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0079391
License Number StateNM

VIII. Authorized Official

Name: MR. RIHHARD TERZICK
Title or Position: CLINICAL DIRECTOR
Credential: MA
Phone: 505-262-1538