| Kewa Pueblo Health Corporation | |
|
85 West Highway 22 Santo Domingo Pueblo NM 87052 | |
| () - | |
| Not Available |
| Full Name | Kewa Pueblo Health Corporation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 85 West Highway 22, Santo Domingo Pueblo, New Mexico |
| Authorized Official Name and Position | Suraj Agboke (BUSINESS OFIICE MANAGER) |
| Authorized Official Contact | 5054653060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kewa Pueblo Health Corporation Po Box 340 Santo Domingo Pueblo NM 87052-0340 Ph: (505) 465-3060 | Kewa Pueblo Health Corporation 85 West Highway 22 Santo Domingo Pueblo NM 87052 Ph: () - |
| NPI Number | 1336659077 |
|---|---|
| Provider Enumeration Date | 10/09/2017 |
| Last Update Date | 10/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336659077 | NPI | - | NPPES |
| 82674060 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Santo Domingo Behavioral Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Tesuque Street, Santo Domingo Pueblo, NM 87052 Phone: 505-465-2733 Fax: 505-465-0433 | |
Santo Domingo Behavioral Health Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Tesuque St, Santo Domingo Pueblo, NM 87052 Phone: 505-465-2733 |