Healthcare Provider Details

I. General information

NPI: 1962074484
Provider Name (Legal Business Name): SOCORRO COUNTY COMMUNITY ALTERNATIVES PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CENTER ST
SOCORRO NM
87801-4559
US

IV. Provider business mailing address

106 CENTER ST
SOCORRO NM
87801-4559
US

V. Phone/Fax

Practice location:
  • Phone: 575-838-0998
  • Fax: 575-838-0244
Mailing address:
  • Phone: 575-838-0998
  • Fax: 575-838-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALITA G MALONEY
Title or Position: CLINICAL SUPERVISOR
Credential: PHD
Phone: 505-792-6726