Organization
SAN JUAN REGIONAL REHABILITATION HOSPITAL, INC.
Active
Parent organization
SAN JUAN REGIONAL MEDICAL CENTER
Other names
Interface Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER
Authorized official
MR. RICKY D. WALLACE FACHE (EXECUTIVE DIRECTOR)
(505) 609-6110
Entity
Organization
Contact information
Practice address
525 S. SCHWARTZ, FARMINGTON, NM 87401-5955
(505) 609-2625
(505) 327-6562
Mailing address
525 S. SCHWARTZ, FARMINGTON, NM 87401-5955
(505) 609-2625
(505) 327-6562
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
6578
NM
283X00000X
Rehabilitation Hospital
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B2236
—
NM
Enumeration date
07/29/2005
Last updated
07/21/2022
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