Healthcare Provider Details

I. General information

NPI: 1235375460
Provider Name (Legal Business Name): REGIONAL SUBSTANCE ABUSE TREATMENT INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 NORTH 10TH. STREET
FORT SUMNER NM
88119
US

IV. Provider business mailing address

519 NORTH 10TH. STREET
FORT SUMNER NM
88119
US

V. Phone/Fax

Practice location:
  • Phone: 575-355-8811
  • Fax: 575-355-8810
Mailing address:
  • Phone: 575-355-8811
  • Fax: 575-355-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMORY CRAWFORD
Title or Position: ADMINISTRATOR
Credential: LPCC
Phone: 575-355-8811