Healthcare Provider Details

I. General information

NPI: 1669539656
Provider Name (Legal Business Name): FOUR WINDS RECOVERY CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 MISSION AVE.
FARMINGTON NM
87401-5008
US

IV. Provider business mailing address

1313 MISSION AVE.
FARMINGTON NM
87401-5008
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-7218
  • Fax: 505-327-0828
Mailing address:
  • Phone: 505-327-7218
  • Fax: 505-327-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number5316
License Number StateNM

VIII. Authorized Official

Name: MS. JOLENE MARIE SCHNEIDER
Title or Position: EXECUTIVE DIRECTOR
Credential: BA, LADAC
Phone: 505-327-7218