Provider Demographics
NPI:1467685644
Name:NEW MEXICO RESOURCE CENTER FOR HEALTH PROFESSIONALS
Entity Type:Organization
Organization Name:NEW MEXICO RESOURCE CENTER FOR HEALTH PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MERRELL-MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LPAT, LADAC
Authorized Official - Phone:505-332-9424
Mailing Address - Street 1:11930 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2478
Mailing Address - Country:US
Mailing Address - Phone:505-332-9242
Mailing Address - Fax:505-332-9140
Practice Address - Street 1:11930 MENAUL BLVD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-332-9242
Practice Address - Fax:505-332-9140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO MONITORED TREATMENT PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health