Healthcare Provider Details

I. General information

NPI: 1760121370
Provider Name (Legal Business Name): NEW MEXICO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MEADOWLARK LN SE
RIO RANCHO NM
87124-1021
US

IV. Provider business mailing address

4210 MEADOWLARK LN SE
RIO RANCHO NM
87124-1021
US

V. Phone/Fax

Practice location:
  • Phone: 505-737-1858
  • Fax:
Mailing address:
  • Phone: 505-737-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHERISH N GARCIA
Title or Position: HR MANAGER
Credential:
Phone: 505-738-6355