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General NPI Number Information
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NPI Number | 1285088963
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Entity Type | Organization
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Legal Business Name | HOZHO CENTER FOR PERSONAL ENHANCEMENT
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 2915 W HISTORIC HWY 66 ROOM 1203
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-870-1483
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Fax | 505-870-1483
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Provider Business Mailing Address
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Address Line | PO BOX 3809
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City | GALLUP
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State | NM
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Zip | 87305-9998
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Country | US
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Telephone | 505-330-1885
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Fax | 505-870-1483
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KEN COLLINS
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Credential |
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Telephone | 505-330-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-0777
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0180441
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 486
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License Number State | NM
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