Provider Demographics
NPI:1336821354
Name:NEW MEXICO WELLNESS
Entity type:Organization
Organization Name:NEW MEXICO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAROS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC
Authorized Official - Phone:505-927-1024
Mailing Address - Street 1:4210 MEADOWLARK LN SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1021
Mailing Address - Country:US
Mailing Address - Phone:505-737-1858
Mailing Address - Fax:505-998-7328
Practice Address - Street 1:1333 PASEO DEL PUEBLO SUR
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5972
Practice Address - Country:US
Practice Address - Phone:575-224-6320
Practice Address - Fax:505-998-7328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder