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General NPI Number Information
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NPI Number | 1982795639
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Entity Type | Organization
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Legal Business Name | STATE OF NEW MEXICO
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5400 GIBSON BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-4729
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Country | US
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Telephone | 505-841-8978
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Fax | 505-383-1190
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Provider Business Mailing Address
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Address Line | 5400 GIBSON BLVD SE BOX 13
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-4729
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Country | US
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Telephone | 505-841-8978
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Fax | 505-383-1190
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEFF LAMURE
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Credential |
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Telephone | 505-383-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 6306
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License Number State | NM
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Taxonomy #2
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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 #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 6306
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 6306
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License Number State | NM
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