Organization
PICURIS PUEBLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG QUANCHELLO LMSW,LADAC,CADC,CS (GOVERNOR, PICURIS PUEBLO)
(575) 587-2519
Entity
Organization
Contact information
Practice address
201 A PUEBLO VIEW ROAD, PENASCO, NM 87553
(575) 587-2519
(505) 579-2660
Mailing address
PO BOX 127, PENASCO, NM 87553
(575) 587-2519
(505) 579-9129
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
3416L0300X
Land Ambulance
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/15/2021
Last updated
03/26/2025
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