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General NPI Number Information
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NPI Number | 1912127630
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Entity Type | Organization
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Legal Business Name | EL CENTRO FAMILY HEALTH
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 901 BACA
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City | LAS VEGAS
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State | NM
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Zip | 87701-2627
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Country | US
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Telephone | 505-454-3218
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Fax | 505-426-2219
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Provider Business Mailing Address
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Address Line | PO BOX 158 538 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2618
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Country | US
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Telephone | 505-753-7218
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Fax | 505-753-5815
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Authorized Official
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Title or Position | CEO
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Name | MRS. LORE PEASE
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Credential |
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Telephone | 505-753-7218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 6205
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License Number State | NM
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