Healthcare Provider Details

I. General information

NPI: 1194104141
Provider Name (Legal Business Name): RECOVERY SERVICES OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S ATKINSON AVE
ROSWELL NM
88203-7154
US

IV. Provider business mailing address

1720 LAKEPOINTE DR STE 117
LEWISVILLE TX
75057-6425
US

V. Phone/Fax

Practice location:
  • Phone: 575-578-4826
  • Fax:
Mailing address:
  • Phone: 214-379-3300
  • Fax: 214-853-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberCL00010987
License Number StateNM

VIII. Authorized Official

Name: BRUCE JARVIE
Title or Position: VP, TREASURER
Credential:
Phone: 214-379-3300