Organization
EL CENTRO FAMILY HEALTH
Active
Other names
El Centro Family Health Espanola Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
608 LA JOYA ST STE B, ESPANOLA, NM 87532-3467
(505) 753-9454
(505) 753-0850
Mailing address
538 N PASEO DE ONATE, P.O. BOX 158, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780689034
ORGANIZATION NPPES
NM
05
—
47953063
—
NM
Enumeration date
05/21/2012
Last updated
06/07/2023
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