Healthcare Provider Details

I. General information

NPI: 1376864645
Provider Name (Legal Business Name): FAITH AND JUSTICE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 7TH ST NW
ALBUQUERQUE NM
87102-3128
US

IV. Provider business mailing address

205 7TH ST NW
ALBUQUERQUE NM
87102-3128
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-5888
  • Fax: 505-243-5071
Mailing address:
  • Phone: 505-243-5888
  • Fax: 505-243-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBIE A. MONTOYA
Title or Position: FLOOR SUPERVISOR
Credential:
Phone: 505-243-8379