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General NPI Number Information
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NPI Number | 1265279947
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Entity Type | Organization
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Legal Business Name | ABRAZOS COMMUNITY HEALING CENTER
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 3600 CERRILLOS RD STE 714E
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City | SANTA FE
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State | NM
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Zip | 87507-2691
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Country | US
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Telephone | 505-750-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 CERRILLOS RD STE 714E
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City | SANTA FE
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State | NM
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Zip | 87507-2691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KEVIN MOELLER
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Credential |
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Telephone | 505-750-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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