Provider Demographics
NPI:1609312750
Name:TOTAL HEALTH RECOVERY,LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH RECOVERY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-692-0204
Mailing Address - Street 1:199 PASEO DE PERALTA
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-3010
Mailing Address - Country:US
Mailing Address - Phone:505-205-1260
Mailing Address - Fax:
Practice Address - Street 1:199 PASEO DE PERALTA
Practice Address - Street 2:STE. D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3010
Practice Address - Country:US
Practice Address - Phone:505-205-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-2886261QM0850X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder