Organization
STREETWISE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS MARQUEZ (EXECUTIVE DIRECTOR)
(505) 323-3785
Entity
Organization
Contact information
Practice address
4312 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4811
(505) 323-3785
(505) 323-3850
Mailing address
4312 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4811
(505) 323-3785
(505) 323-3850
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
600153
NM
251S00000X
Community/Behavioral Health Agency
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NM600153
—
NM
Enumeration date
02/21/2007
Last updated
07/21/2022
Update your record
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