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NPI Code Detail

MEDICARE: STATE OF THE HEART RECOVERY

MEDICARE: STATE OF THE HEART RECOVERY
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

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 : 1871137042
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF THE HEART RECOVERY
Provider Business Mailing Address
First Line : 203 CALIFORNIA ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1802
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 203 CALIFORNIA ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1802
Country : US
Telephone Number : 505-688-1228
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : PAUL THOMAS CHAVEZ
Credential : LPCC
Telephone Number : 505-688-1228
Provider Enumeration Date : 10/31/2019
Last Update Date : 05/03/2024

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Directions to “STATE OF THE HEART RECOVERY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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