Organization
FNCH SBHC NACA HIGH SCHOOL
Active
Parent organization
FIRST NATIONS COMMUNITY HEALTH SOURCE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIRST NATIONS COMMUNITY HEALTH SOURCE, INC.
Authorized official
JUANITA J WIDENER (BILLING MANAGER)
(505) 262-6588
Entity
Organization
Contact information
Practice address
1711 STANFORD DR NE, ALBUQUERQUE, NM 87106-2535
(505) 262-2481
(505) 265-7045
Mailing address
5608 ZUNI RD SE, ALBUQUERQUE, NM 87108-2926
(505) 262-6588
(505) 262-7045
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00046912
—
NM
Enumeration date
03/21/2018
Last updated
10/08/2024
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