Provider Demographics
NPI:1962074484
Name:SOCORRO COUNTY COMMUNITY ALTERNATIVES PROGRAM
Entity type:Organization
Organization Name:SOCORRO COUNTY COMMUNITY ALTERNATIVES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-792-6726
Mailing Address - Street 1:106 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4559
Mailing Address - Country:US
Mailing Address - Phone:575-838-0998
Mailing Address - Fax:575-838-0244
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4559
Practice Address - Country:US
Practice Address - Phone:575-838-0998
Practice Address - Fax:575-838-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1649569575OtherNPI
AK1275551855OtherNPI
NM1891046314OtherNPI