Provider Demographics
NPI:1467795336
Name:FIRST NATIONS COMMUNITY HEALTHSOURCE INC
Entity Type:Organization
Organization Name:FIRST NATIONS COMMUNITY HEALTHSOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SON-STONE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:505-262-2481
Mailing Address - Street 1:5608 ZUNI RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2926
Mailing Address - Country:US
Mailing Address - Phone:052-622-4815
Mailing Address - Fax:505-262-0781
Practice Address - Street 1:625 TRUMAN ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6443
Practice Address - Country:US
Practice Address - Phone:505-262-2481
Practice Address - Fax:505-262-0781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST NATIONS COMMUNITY HEALTHSOURCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00046912Medicaid