Healthcare Provider Details

I. General information

NPI: 1003096264
Provider Name (Legal Business Name): SANGRE DE CRISTO COMMUNITY HEALTH PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 S SAINT FRANCIS DR
SANTA FE NM
87505-4037
US

IV. Provider business mailing address

1441 S SAINT FRANCIS DR
SANTA FE NM
87505-4037
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-8870
  • Fax: 505-982-4480
Mailing address:
  • Phone: 505-982-8870
  • Fax: 505-982-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ARTURO N GONZALES
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D
Phone: 505-982-8870