Provider Demographics
NPI:1215095955
Name:SAN JUAN COLLEGE FAMILY RESOURCE CENTER
Entity type:Organization
Organization Name:SAN JUAN COLLEGE FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-566-3825
Mailing Address - Street 1:4601 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4609
Mailing Address - Country:US
Mailing Address - Phone:505-566-3825
Mailing Address - Fax:
Practice Address - Street 1:3539 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8801
Practice Address - Country:US
Practice Address - Phone:505-566-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM251S0000XOtherCOMMUNITY BEHAVIORAL HEAL
NM251B0000XOtherCASE MANAGEMENT