Provider Demographics
NPI:1558703314
Name:FIRST NATIONS NACA SBHC
Entity Type:Organization
Organization Name:FIRST NATIONS NACA SBHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SON-STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-262-6546
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:505-262-2481
Mailing Address - Fax:
Practice Address - Street 1:1000 INDIAN SCHOOL RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2304
Practice Address - Country:US
Practice Address - Phone:505-262-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST NATIONS COMMUNITY HEALTHSOURCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM321884Medicare PIN