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NPI Code Detail

MEDICARE: THE FAMILY CONNECTION LLC

MEDICARE: THE FAMILY CONNECTION LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyPT0088431NM
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3251S00000XCommunity/Behavioral Health AgencyNM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790970879
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FAMILY CONNECTION LLC
Provider Business Mailing Address
First Line : 2441 CABEZON BLVD SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124
Country : US
Telephone Number : 505-717-1155
Fax Number : 505-717-1473
Provider Business Practice Location Address
First Line : 6001 WHITEMAN DR NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2196
Country : US
Telephone Number : 505-717-1155
Fax Number : 505-717-1473
Authorized Official
Title or Position : CEO
Name : AMANDA S DAVISON
Credential :
Telephone Number : 505-717-1155
Provider Enumeration Date : 09/11/2007
Last Update Date : 12/27/2023

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Directions to “THE FAMILY CONNECTION LLC ” Practice Location

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