Healthcare Provider Details

I. General information

NPI: 1548323926
Provider Name (Legal Business Name): RIO ARRIBA HEALTH AND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N PASEO DE ONATE
ESPANOLA NM
87532-3454
US

IV. Provider business mailing address

P.O. BOX 94508
ALBUQUERQUE NM
87199-5408
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-3143
  • Fax: 505-753-1769
Mailing address:
  • Phone: 505-384-7352
  • Fax: 505-274-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberM04710
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREN I REICHELT
Title or Position: DIRECTOR-HEALTH & HUMAN SERVICES
Credential:
Phone: 505-753-3143