Healthcare Provider Details

I. General information

NPI: 1154980621
Provider Name (Legal Business Name): SANDHILL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 JEMEZ DRIVE
LOS LUNAS NM
87031
US

IV. Provider business mailing address

15 JEMEZ DRIVE
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-9271
  • Fax: 505-866-9278
Mailing address:
  • Phone: 505-866-9271
  • Fax: 505-866-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN ALEXY
Title or Position: FISCAL OPERATIONS MANAGER
Credential:
Phone: 505-866-9271