Santa Fe Recovery Center Inc
Organization Active NPI Substance Abuse Rehabilitation Facility · Gallup, NM
NPI 1033716972 · NPPES record last updated Mar 4, 2025
Key facts
- NPI
- 1033716972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- SANTA FE RECOVERY CENTER INC
- Practice address
- 2105 Hasler Valley Rd
Gallup, NM 87301 - Phone
- (505) 471-9856
- NPI assigned
- Oct 5, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- SANTA FE RECOVERY CENTER INC
Authorized official
- Name
- Elisa Schleusener
- Title
- Credentialing Manager
- Phone
- (505) 847-5422
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 9
Practitioners 18
-
Latara Anderson, LCSW
-
Allison Begay, LMSW
-
Jeremiah Quinton Billie, LMHC
-
William Anthony Burrola, CPSW
-
Emerson Charley, LSAA
-
Sylvia M Knotts, LMSW
-
James Hunter Lange, LADAC
-
Michelle Renee' Morales, LMSW
-
Gabrielle Myers, LMHC
-
Barry Christopher Ore, LPCC
-
Juliana Marie Stravers, LPCC
-
Tyrone Jon Kay, LADAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2204795 | Santa Fe Recovery Center Inc | Certificate of waiver | Dec 9, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260422003040 | NM | Part B Supplier - Clinic/Group Practice | 4385055417 |
Receives reassigned benefits from 2 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Santa Fe, NM; Gallup, NM |
National Provider Directory
- Tax ID family
- Santa Fe Recovery Center
- Part of
- Santa Fe Recovery Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Group Psychotherapy Psychologist |
103TP2701X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
2105 Hasler Valley Rd
Gallup, NM 87301
Mailing address
2504 Camino Entrada
Santa Fe, NM 87507-4851
Phone (505) 471-4985
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82536716 | Medicaid | NM |
Other names
- Four Corners Detox Recovery
Other providers in Gallup, NM
- Nakia Sanders
- Wykeia Monique Sanders
- Brandi L Sandoval
- Brittany D Sandoval
- Santa Fe Recovery Center
- Santa Fe Recovery Center Inc
- Santa Fe Recovery Center Inc
- Santa Fe Recovery Center Inc
- Loren D Santa Maria
- Argenis Santamaria LMSW
All providers in Gallup, NM · Substance Abuse Rehabilitation Facility in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.