State of the Heart Recovery
Organization Active NPI Methadone Clinic · Albuquerque, NM
NPI 1700407277 · NPPES record last updated Mar 26, 2021
Key facts
- NPI
- 1700407277
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- STATE OF THE HEART RECOVERY
- Practice address
- 203 California St NE
Albuquerque, NM 87108-1802 - Phone
- (505) 308-8296
- NPI assigned
- May 6, 2020
- Organization subpart
- No
Authorized official
- Name
- Paul Thomas Chavez, LPCC
- Title
- Executive Director
- Phone
- (505) 688-1228
Corporate family (same tax ID) 1
Practitioners 5
-
Julia Camacho, LMSW
-
Diane C. Clawson, D.O.
-
Tracey J Folland, LPCC
-
Richard J Levine, PHARM.D.
-
David Michael Melamed, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Opioid treatment program
- Medicare-enrolled since Mar 26, 2021
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201201000062 | NM | Part B Supplier - Opioid Treatment Program (Otp) | 0244641058 | Practice locations: Albuquerque, NM |
National Provider Directory
- Tax ID family
- State of the Heart Recovery
Locations
203 California St NE
Albuquerque, NM 87108
Phone (505) 206-0288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Yes |
Addresses
Primary practice location
203 California St NE
Albuquerque, NM 87108-1802
Mailing address
203 California St NE
Albuquerque, NM 87108-1802
Phone (505) 308-8296
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | MEDEZMST.GOTNGCS.com | Direct |
Other providers in Albuquerque, NM
- Shannon G Starr
- Starseed Neuroaffirming Wellness LLC
- State of New Mexico
- State of New Mexico Dept. of Finance and Administrative Cent Payroll
- State of the Art Healing, LLC
- State of the Heart Recovery
- State of the Heart Recovery Inc.
- Ruby Staten
- Stateserv Medical of New Mexico LLC
- Abigail Statkus
All providers in Albuquerque, NM · Methadone Clinic 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 26, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.