Organization
SOUTHWEST RECOVERY AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D. MILLER (PRESIDENT)
(323) 854-8587
Entity
Organization
Contact information
Practice address
3874 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4479
(505) 896-9412
(505) 895-2505
Mailing address
914 PINEHURST RD SE, RIO RANCHO, NM 87124-2219
(323) 854-8587
(505) 896-2505
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568643146
—
NM
Enumeration date
03/13/2018
Last updated
03/13/2018
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