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General NPI Number Information
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NPI Number | 1407676679
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Entity Type | Organization
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Legal Business Name | FNCH INTEGRATED CARE MOBILE MEDICAL VAN
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 5608 ZUNI RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2926
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Country | US
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Telephone | 505-262-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 5608 ZUNI RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2926
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Country | US
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Telephone | 505-262-2481
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LINDA STONE
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Credential |
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Telephone | 505-262-6546
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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