NPIMap

Organization Active NPI

Santa Fe Recovery Center Inc

Doing business as Four Corners Recovery Detox

  • Community/Behavioral Health Agency
  • Gallup, NM
National Provider Identifier
1881429652
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SANTA FE RECOVERY CENTER INC
Doing business as
Four Corners Recovery Detox
Practice address
2022 E Aztec Ave
Gallup, NM 87301-4804
Phone
(505) 471-4985
NPI assigned
Sep 3, 2024
Last updated
Sep 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SANTA FE RECOVERY CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Elisa Schleusener
Title
HR
Phone
(505) 847-5422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

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 1

  • Four Corners Recovery Detox Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2306389Santa Fe Recovery Center Inc2022 East Aztec Ave, Gallup, NM 87301Certificate of waiverJun 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Santa Fe Recovery Center Inc10 organizations share this tax ID, including this one
Part of
Santa Fe Recovery Center Inc

Other organizations with this tax ID 9

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": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1881429652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 CAMINO ENTRADA",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875074851",
            "telephone_number": "505-847-5422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2022 E AZTEC AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014804",
            "telephone_number": "505-471-4985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA FE RECOVERY CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANTA FE RECOVERY CENTER INC",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "SCHLEUSENER",
        "authorized_official_first_name": "ELISA",
        "authorized_official_title_or_position": "HR",
        "authorized_official_telephone_number": "505-847-5422"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Corners Recovery Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gallup, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.