Provider Demographics
NPI:1578995676
Name:SANTA FE RECOVERY CENTER DBA SANTA FE RECOVERY CENTER
Entity Type:Organization
Organization Name:SANTA FE RECOVERY CENTER DBA SANTA FE RECOVERY CENTER
Other - Org Name:SANTA FE RECOVERY CENTER DETOX
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-270-3966
Mailing Address - Street 1:2504 CAMINO ENTRADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4851
Mailing Address - Country:US
Mailing Address - Phone:505-471-4985
Mailing Address - Fax:505-471-6084
Practice Address - Street 1:2052 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2100
Practice Address - Country:US
Practice Address - Phone:505-471-4985
Practice Address - Fax:505-471-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5382324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility