| A New Awakening Rio Rancho | |
|
1207 Golf Course Rd Se Suite C Rio Rancho NM 87124-1999 | |
| (505) 994-4100 | |
| (505) 994-1229 |
| Full Name | A New Awakening Rio Rancho |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1207 Golf Course Rd Se, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Erick Brian Pacheco (OWNER) |
| Authorized Official Contact | 5054894935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A New Awakening Rio Rancho 412 Asbury Rd Ne Suite C Rio Rancho NM 87124-5627 Ph: (505) 489-4935 | A New Awakening Rio Rancho 1207 Golf Course Rd Se Suite C Rio Rancho NM 87124-1999 Ph: (505) 994-4100 |
| NPI Number | 1568866085 |
|---|---|
| Provider Enumeration Date | 10/13/2014 |
| Last Update Date | 07/05/2016 |
| Medicare PECOS PAC ID | 8325345861 |
|---|---|
| Medicare Enrollment ID | O20160328001366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568866085 | NPI | - | NPPES |
| 93588755 | Medicaid | NM | |
| 32D2113373 | Other | NM | CLINICAL LABORATORY IMPROVMENT AMENDMENTS CERTIFICATE OF WAIVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Edmundo E Apodaca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215029574 PECOS PAC ID: 0042461626 Enrollment ID: I20160328002200 |
| Provider Name | Angelica Cravens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255970620 PECOS PAC ID: 8426491754 Enrollment ID: I20240202004021 |
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