Healthcare Provider Details

I. General information

NPI: 1912542739
Provider Name (Legal Business Name): MR. JOHN CHARLES REHM IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 N MANN DR
SILVER CITY NM
88061-5900
US

IV. Provider business mailing address

114 W 11TH ST
SILVER CITY NM
88061-5136
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-2011
  • Fax:
Mailing address:
  • Phone: 575-388-1511
  • Fax: 575-313-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0218871
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: