Healthcare Provider Details

I. General information

NPI: 1891688636
Provider Name (Legal Business Name): PECOS VALLEY PUBLIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST STE 516
ROSWELL NM
88203-4676
US

IV. Provider business mailing address

200 W 1ST ST STE 516
ROSWELL NM
88203-4676
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-3068
  • Fax:
Mailing address:
  • Phone: 505-600-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA MERZ
Title or Position: DIRECTOR
Credential: NRAEMT
Phone: 832-757-8388