Healthcare Provider Details

I. General information

NPI: 1952793648
Provider Name (Legal Business Name): COMMUNITY THERAPIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MANANA BLVD STE 1
CLOVIS NM
88101-3503
US

IV. Provider business mailing address

100 E MANANA BLVD STE 1
CLOVIS NM
88101-3503
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-2243
  • Fax: 575-762-6452
Mailing address:
  • Phone: 575-366-5014
  • Fax: 575-366-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN C JIMENEZ
Title or Position: OWNER
Credential: P.T.
Phone: 575-366-5014