Provider Demographics
NPI:1609122753
Name:ALEJANDRO SUBSTANCE ABUSE, LLC
Entity Type:Organization
Organization Name:ALEJANDRO SUBSTANCE ABUSE, LLC
Other - Org Name:ALEJANDRO SUBSTANCE ABUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LADAC
Authorized Official - Phone:505-617-5846
Mailing Address - Street 1:713 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4532
Mailing Address - Country:US
Mailing Address - Phone:505-425-2687
Mailing Address - Fax:505-454-7198
Practice Address - Street 1:713 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4532
Practice Address - Country:US
Practice Address - Phone:505-425-2687
Practice Address - Fax:505-454-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty