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General NPI Number Information
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NPI Number | 1396655874
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Entity Type | Organization
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Legal Business Name | SANDIA PURPOSE RECOVERY SERVICES
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 5001 ELLISON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4326
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Country | US
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Telephone | 505-730-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 ARCADIAN TRL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3404
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Country | US
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Telephone | 505-730-2428
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | RANDY JOSEPH GUTIERREZ
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Credential | CPSW
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Telephone | 505-730-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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