Healthcare Provider Details

I. General information

NPI: 1508840117
Provider Name (Legal Business Name): MORA VALLEY COMMUNITY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MORA VALLEY CLINIC RD
MORA NM
87732-2202
US

IV. Provider business mailing address

PO BOX 209
MORA NM
87732-0209
US

V. Phone/Fax

Practice location:
  • Phone: 877-271-2201
  • Fax:
Mailing address:
  • Phone: 877-271-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number6333
License Number StateNM

VIII. Authorized Official

Name: MRS. CARLA MELENDEZ
Title or Position: CFO
Credential:
Phone: 877-271-2201