Healthcare Provider Details

I. General information

NPI: 1851428577
Provider Name (Legal Business Name): SANTA MARIA EL MIRADOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 A VAN NU PO
SANTA FE NM
87508
US

IV. Provider business mailing address

10 A VAN NU PO
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-7700
  • Fax: 505-395-7452
Mailing address:
  • Phone: 505-424-7700
  • Fax: 505-395-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ROMERO
Title or Position: CEO
Credential:
Phone: 505-424-7700