NPIMap

Organization Active NPI

State of New Mexico

  • Special Hospital
  • Roswell, NM
National Provider Identifier
1578075016
Registry record updated Oct 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Special HospitalTaxonomy code 284300000X
License
6026 Issued in NM
Legal business name
STATE OF NEW MEXICO
Practice address
72 Gail Harris St
Roswell, NM 88203-8116
Phone
(575) 347-3400
Fax
(575) 347-5177
NPI assigned
Oct 24, 2017
Organization subpart
Yes
Parent organization
STATE OF NEW MEXICOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2017

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

Authorized official

Name
Jose Luis Gurrola
Title
Administrator
Phone
(575) 347-3410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Special Hospital 284300000X 6026 NM Primary

Addresses

Primary practice location

72 Gail Harris St
Roswell, NM 88203-8116

Mailing address

72 Gail Harris St
Roswell, NM 88203-8116
Phone (575) 347-3400

Other identifiers 1

IdentifierTypeStateIssuer
0273MedicaidNM

Other names 1

  • new mexico rehabilitation center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Scientific Laboratory Division Nmdoh43 organizations share this tax ID, including this one
Part of
Scientific Laboratory Division Nmdoh

Other organizations with this tax ID 42

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

View all 42

Locations

72 Gail Harris St
Roswell, NM 88203
Phone (575) 347-3400

NPI Registry JSON

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1578075016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 GAIL HARRIS ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882038116",
            "telephone_number": "575-347-3400",
            "fax_number": "575-347-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 GAIL HARRIS ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882038116",
            "telephone_number": "575-347-3400",
            "fax_number": "575-347-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW MEXICO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW MEXICO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "GURROLA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "575-347-3410"
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "NM",
            "license": "6026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0273",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "new mexico rehabilitation center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.