Healthcare Provider Details

I. General information

NPI: 1285177675
Provider Name (Legal Business Name): OR FACTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE STE 670C
ROSWELL NM
88201-4755
US

IV. Provider business mailing address

400 N PENNSYLVANIA AVE STE 670C
ROSWELL NM
88201-4755
US

V. Phone/Fax

Practice location:
  • Phone: 575-420-7336
  • Fax: 575-627-5721
Mailing address:
  • Phone: 575-623-7336
  • Fax: 575-623-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SHANNON BYRNE
Title or Position: OWNER
Credential: LCSW
Phone: 575-420-7336