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General NPI Number Information
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NPI Number | 1962580175
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Entity Type | Organization
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Legal Business Name | GREATER SANTA ROSA COUNCIL ON ALCOHOLISM
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 1047 LAKE DR
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City | SANTA ROSA
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State | NM
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Zip | 88435-2561
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Country | US
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Telephone | 575-472-5383
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Fax |
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Provider Business Mailing Address
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Address Line | 419 S 2ND ST
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City | TUCUMCARI
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State | NM
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Zip | 88401-2859
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Country | US
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Telephone | 505-461-3572
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Fax | 505-461-3572
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF OPERATIONS
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Name | CAYETANA ZAMORA
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Credential |
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Telephone | 575-472-5383
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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 | LISW 1041CO700X
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License Number State | NM
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