Healthcare Provider Details

I. General information

NPI: 1790192847
Provider Name (Legal Business Name): UNION COMMUNITY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MAIN ST STE 2
LAS CRUCES NM
88005-2917
US

IV. Provider business mailing address

1100 S MAIN ST STE 2
LAS CRUCES NM
88005-2917
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-8114
  • Fax:
Mailing address:
  • Phone: 575-650-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. DARREN MICHAEL BROWN
Title or Position: COO
Credential: LISW/LCSW
Phone: 575-650-8114