Provider Demographics
NPI:1205246667
Name:RECOVERY SERVICES OF SOUTHERN NEW MEXICO LLC
Entity type:Organization
Organization Name:RECOVERY SERVICES OF SOUTHERN NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-884-1214
Mailing Address - Street 1:1235 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5044
Mailing Address - Country:US
Mailing Address - Phone:505-717-2397
Mailing Address - Fax:505-717-2498
Practice Address - Street 1:1235 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5044
Practice Address - Country:US
Practice Address - Phone:505-717-2397
Practice Address - Fax:505-717-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty