Organization
SANTA ANA PUEBLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CAMPBELL LCSW (HEALTH AND HUMAN SERVICES DIRECTOR)
(505) 967-9791
Entity
Organization
Contact information
Practice address
02 DOVE RD, SANTA ANA PUEBLO, NM 87004-5906
(505) 771-6759
Mailing address
02 DOVE RD, SANTA ANA PUEBLO, NM 87004-5906
(505) 771-6759
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
293781631
EMP #
—
Enumeration date
01/12/2023
Last updated
01/24/2024
Update your record
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