Organization
EL CENTRO FAMILY HEALTH
Active
Other names
El Centro Family Health NMHU Highlands Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
901 BACA, LAS VEGAS, NM 87701-2627
(505) 454-3218
(505) 426-2219
Mailing address
PO BOX 158, 538 N PASEO DE ONATE, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
6205
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780689034
ORGANIZATION NPPES
NM
05
—
321930
—
NM
Enumeration date
04/26/2007
Last updated
11/24/2014
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