NPIMap

Organization Active NPI

San Juan College

  • Community/Behavioral Health Agency
  • Farmington, NM
National Provider Identifier
1538414727
Registry record updated Jul 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
M-07674 Issued in NM
Legal business name
SAN JUAN COLLEGE
Practice address
4601 College Blvd
Farmington, NM 87402-4609
Phone
(505) 566-3846
Fax
(505) 566-3687
NPI assigned
Jul 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nicole Deherrera, LMSW
Title
Program Director
Phone
(505) 566-3846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X M-07674 NM Primary

Addresses

Primary practice location

4601 College Blvd
Farmington, NM 87402-4609

Mailing address

4601 College Blvd
Farmington, NM 87402-4609
Phone (505) 566-3846

Other names 1

  • Children's Behavioral Health Program Other name

National Provider Directory

National Provider Directory
Tax ID family
San Juan College4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1538414727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 COLLEGE BLVD",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874024609",
            "telephone_number": "505-566-3846",
            "fax_number": "505-566-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 COLLEGE BLVD",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874024609",
            "telephone_number": "505-566-3846",
            "fax_number": "505-566-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "DEHERRERA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "505-566-3846",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "M-07674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Behavioral Health Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.