NPI 1063641819

Nm Department of Health

Organisation Substance Abuse Rehabilitation Facility Fort Bayard, NM

Practice location

Address: 100 Calle de Central, Fort Bayard, NM 88036
Phone: (575) 537-8831
Fax: (575) 537-8886
Mailing address: PO Box 36216, Fort Bayard, NM 88036-6216

Authorised official

Name: Alfred Corona Chavez
Title: Clinical Supervisor
Phone: (575) 537-8831

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 5610 (NM)

Other Substance Abuse Rehabilitation Facility providers in New Mexico →

Registry record

NPI: 1063641819
Entity type: Organization
NPI issued: 14 Jul 2009
Record last updated: 14 Jul 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.