Provider Demographics
NPI:1053632851
Name:SOUTHWEST CARES NV LLC
Entity Type:Organization
Organization Name:SOUTHWEST CARES NV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-982-3113
Mailing Address - Street 1:P.O. BOX 32390
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2390
Mailing Address - Country:US
Mailing Address - Phone:505-982-3113
Mailing Address - Fax:505-982-2462
Practice Address - Street 1:119 EAST MARCY ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2046
Practice Address - Country:US
Practice Address - Phone:505-982-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty