Organization
SANTO DOMINGO PUEBLO
Active
Other names
Kewa Family Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS JEROME O'LAUGHLIN (DIRECTOR)
(505) 709-8259
Entity
Organization
Contact information
Practice address
18 EAGLE CT # 87052, SANTO DOMINGO PUEBLO, NM 87052-1230
(505) 465-2733
Mailing address
PO BOX 130, SANTO DOMINGO PUEBLO, NM 87052-0130
(505) 465-2733
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
07/11/2007
Last updated
07/09/2026
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