Santa Fe Recovery Center Inc
Organization Active NPI Community/Behavioral Health Agency · Gallup, NM
NPI 1881429652 · NPPES record last updated Sep 3, 2024
Key facts
- NPI
- 1881429652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- SANTA FE RECOVERY CENTER INC
- Practice address
- 2022 E Aztec Ave
Gallup, NM 87301-4804 - Phone
- (505) 471-4985
- NPI assigned
- Sep 3, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- SANTA FE RECOVERY CENTER INC
Authorized official
- Name
- Elisa Schleusener
- Title
- HR
- Phone
- (505) 847-5422
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 9
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2306389 | Santa Fe Recovery Center Inc | Certificate of waiver | Jun 16, 2028 |
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 |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2022 E Aztec Ave
Gallup, NM 87301-4804
Mailing address
2504 Camino Entrada
Santa Fe, NM 87507-4851
Phone (505) 847-5422
Other names
- Four Corners Recovery Detox
Other providers in Gallup, NM
- 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
- Georgina Santiago- Cruz
- Cynthia Denice Santiago-Morales
- Gregory Santiago
All providers in Gallup, NM · Community/Behavioral Health Agency 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 Sep 3, 2024. 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.