Organization
EL CENTRO FAMILY HEALTH
Active
Other names
El Centro Family Health Penasco Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE CEO (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
15136 ST. RD., PENASCO, NM 87553-0000
(575) 587-2809
(575) 587-2605
Mailing address
538 N PASEO DE ONATE, P.O. BOX 158, ESPANOLA, NM 87532-2618
(505) 752-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780689034
ORGANIZATION NPPES
NM
05
—
47092
—
NM
Enumeration date
05/21/2012
Last updated
06/07/2023
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