Healthcare Provider Details

I. General information

NPI: 1902437817
Provider Name (Legal Business Name): PIECES FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE M5
SANTA FE NM
87505-2106
US

IV. Provider business mailing address

2255 CAMINO IRIS
SANTA FE NM
87505-4953
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-0191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TOMAS WEILER
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 505-433-2755