# KEWA PUEBLO HEALTH CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KEWA PUEBLO HEALTH CORPORATION
- **Other names:** Santo Domingo Health Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558648709
- **Legal business name:** KEWA PUEBLO HEALTH CORPORATION
- **Authorized official:** VANESSA DIANA VIGIL (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (505) 465-3060

## Contact information

- **Practice address:** 85 W HIGHWAY 22, SANTO DOMINGO, NM 87052-0340
- **Practice address phone:** (505) 465-3060
- **Practice address fax:** (505) 465-1191
- **Mailing address:** PO BOX 559, SANTO DOMINGO PUEBLO, NM 87052-0559
- **Mailing address phone:** (505) 465-3060
- **Mailing address fax:** (505) 465-1191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2011
- **Last updated:** 11/15/2011