Provider Demographics
NPI:1598815151
Name:ARROYO CHAMISO PEDIATRIC REHABILITATION
Entity type:Organization
Organization Name:ARROYO CHAMISO PEDIATRIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:POLLARD
Authorized Official - Last Name:VAN HECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC SLP
Authorized Official - Phone:505-995-4860
Mailing Address - Street 1:871 DON CUBERO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-989-9635
Mailing Address - Fax:
Practice Address - Street 1:871 DON CUBERO AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-989-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM491282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital