Organization
KEWA PUEBLO HEALTH CORPORATION
Active
Parent organization
KEWA PUEBLO HEALTH CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
KEWA PUEBLO HEALTH CORPORATION
Authorized official
MR. SURAJ AGBOKE (BUSINESS OFIICE MANAGER)
(505) 465-3060
Entity
Organization
Contact information
Practice address
85 WEST HIGHWAY 22, SANTO DOMINGO PUEBLO, NM 87052
Mailing address
PO BOX 340, SANTO DOMINGO PUEBLO, NM 87052-0340
(505) 465-3060
(505) 465-1155
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82674060
—
NM
Enumeration date
10/09/2017
Last updated
03/18/2026
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