Organization
EL CENTRO FAMILY HEALTH
Active
Other names
El Centro Family Health MMS SBHC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
947 OLD NATIONAL ROAD, LAS VEGAS, NM 87701
(505) 454-2794
Mailing address
538 N PASEO DE ONATE, P.O. BOX 158, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 853-5815
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
3394
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780689034
NPPES
NM
Enumeration date
09/17/2014
Last updated
03/22/2016
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