Organization Name: | EL CENTRO FAMILY HEALTH |
NPI Number: | 1003183393 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORE PEASE (CEO) |
Mailing Address: | 235 Paseo Del Canon E Taos |
State: | NM US |
Postal Code: | 875716239 |
Phone Number: | 5757518032 |
Fax Number: | 5757587088 |
NPI Enumeration Date: | 11/30/2011 |
NPI Last Update Date: | 11/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 3516 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |