Healthcare Provider Details

I. General information

NPI: 1780677039
Provider Name (Legal Business Name): CIBOLA GENERAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 E ROOSEVELT AVE
GRANTS NM
87020-2118
US

IV. Provider business mailing address

1016 E ROOSEVELT AVE
GRANTS NM
87020-2118
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-5300
  • Fax: 505-287-5309
Mailing address:
  • Phone: 505-287-5202
  • Fax: 505-287-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number6079
License Number StateNM

VIII. Authorized Official

Name: ELIZABETH SELLERS
Title or Position: CEO
Credential:
Phone: 505-287-5300