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General NPI Number Information
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NPI Number | 1346238110
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Entity Type | Organization
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Legal Business Name | OTERO COUNTY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 850 WRIGHT AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-7367
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Country | US
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Telephone | 505-437-8942
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Fax | 505-437-8980
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Provider Business Mailing Address
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Address Line | PO BOX 1561
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City | ALAMOGORDO
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State | NM
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Zip | 88311-1561
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Country | US
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Telephone | 505-437-8942
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Fax | 505-437-8980
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SANTIAGO RODRIGUEZ JR.
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Credential | LADAC
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Telephone | 505-437-8942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 5371
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License Number State | NM
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