Provider Demographics
NPI:1194443135
Name:BEN ARCHER HEALTH CENTER
Entity type:Organization
Organization Name:BEN ARCHER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-267-3280
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:1300 S IRON ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5040
Practice Address - Country:US
Practice Address - Phone:575-543-1017
Practice Address - Fax:575-544-0115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEN ARCHER HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)