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General NPI Number Information
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NPI Number | 1265272207
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Entity Type | Organization
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Legal Business Name | ZELEVIE OUTPATIENT THERAPY LLC
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 201 NELSON AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-3374
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Country | US
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Telephone | 505-675-4545
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Fax | 505-436-2763
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Provider Business Mailing Address
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Address Line | 201 NELSON AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-3374
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Country | US
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Telephone | 505-675-4545
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Fax | 505-436-2763
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JONATHAN ANDERSON
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Credential |
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Telephone | 505-675-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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