Provider Demographics
NPI:1144386830
Name:WESTERN CLINICAL HEALTH SERVICES
Entity Type:Organization
Organization Name:WESTERN CLINICAL HEALTH SERVICES
Other - Org Name:ALBUQUERQUE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TERZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-262-1538
Mailing Address - Street 1:209 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1508
Mailing Address - Country:US
Mailing Address - Phone:505-262-1538
Mailing Address - Fax:505-243-5342
Practice Address - Street 1:209 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1508
Practice Address - Country:US
Practice Address - Phone:505-262-1538
Practice Address - Fax:505-243-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRW0336001261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder