Organization
EL CENTRO FAMILY HEALTH
Active
Other names
El Centro Family Health Maxwell SBHC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
4TH & PARQUE AVENUE, MAXWELL, NM 87728-0275
(575) 375-2389
(575) 375-2379
Mailing address
538 N PASEO DE ONATE, P.O. BOX 158, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780689034
ORGANIZATION NPPES
NM
05
—
20920334
—
NM
Enumeration date
08/16/2011
Last updated
11/20/2015
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