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Organization

EL CENTRO FAMILY HEALTH

Active
Other names
El Centro Family Health Bond Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization

Contact information

Practice address
711 BOND ST., ESPANOLA, NM 87532-2729
(505) 753-9503
(505) 747-1004
Mailing address
PO BOX 158, 538 N PASEO DE ONATE, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
118395554
NM
01
1780689034
ORGANIZATION NPPES
NM
Enumeration date
10/21/2011
Last updated
11/25/2014
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