Healthcare Provider Details

I. General information

NPI: 1134663545
Provider Name (Legal Business Name): COMMUNITY SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 COMMUNITY WAY
PORTALES NM
88130-6600
US

IV. Provider business mailing address

1100 COMMUNITY WAY
PORTALES NM
88130-6600
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-8576
  • Fax: 575-356-8031
Mailing address:
  • Phone: 575-356-8576
  • Fax: 575-356-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number5468
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOSIE M MADRID
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-356-8576