Four Corners Detox Recovery | |
2105 Hasler Valley Rd Gallup NM 87305 | |
(505) 471-9856 | |
Not Available |
Full Name | Four Corners Detox Recovery |
---|---|
Speciality | Substance Abuse Rehabilitation Facility |
Location | 2105 Hasler Valley Rd, Gallup, New Mexico |
Authorized Official Name and Position | Lou Duran (CREDENTIALING AND BILLING) |
Authorized Official Contact | 5052703966 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Four Corners Detox Recovery 2504 Camino Entrada Santa Fe NM 87507-4851 Ph: (505) 471-4985 | Four Corners Detox Recovery 2105 Hasler Valley Rd Gallup NM 87305 Ph: (505) 471-9856 |
NPI Number | 1033716972 |
---|---|
Provider Enumeration Date | 10/05/2020 |
Last Update Date | 11/25/2023 |
Certification Date | 11/25/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033716972 | NPI | - | NPPES |
82536716 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Secondary |
324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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