Healthcare Provider Details

I. General information

NPI: 1265279947
Provider Name (Legal Business Name): ABRAZOS COMMUNITY HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD STE 714E
SANTA FE NM
87507-2691
US

IV. Provider business mailing address

3600 CERRILLOS RD STE 714E
SANTA FE NM
87507-2691
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-0558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KEVIN MOELLER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 505-750-0558