Provider Demographics
NPI:1720367105
Name:SOUTHWEST CARES CA LLC
Entity Type:Organization
Organization Name:SOUTHWEST CARES CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-982-3113
Mailing Address - Street 1:PO BOX 32390
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2390
Mailing Address - Country:US
Mailing Address - Phone:505-982-3113
Mailing Address - Fax:505-982-2462
Practice Address - Street 1:552 AGUA FRIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2508
Practice Address - Country:US
Practice Address - Phone:505-982-3113
Practice Address - Fax:505-982-2462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty