Provider Demographics
NPI:1326570425
Name:FNCH SBHC WILSON LOCATION
Entity Type:Organization
Organization Name:FNCH SBHC WILSON LOCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEFR EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SON STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-262-6588
Mailing Address - Street 1:PO BOX 82610
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-2610
Mailing Address - Country:US
Mailing Address - Phone:505-262-6588
Mailing Address - Fax:505-265-7045
Practice Address - Street 1:1138 CARDENAS DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4809
Practice Address - Country:US
Practice Address - Phone:505-262-2481
Practice Address - Fax:505-265-7045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST NATIONS COMMUNITY HEALTHSOURCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)