| Kewa Pueblo Health Corporation | |
|
85 W Highway 22 Santo Domingo NM 87052-0340 | |
| (505) 465-3060 | |
| (505) 465-1191 |
| Full Name | Kewa Pueblo Health Corporation |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 85 W Highway 22, Santo Domingo, New Mexico |
| Authorized Official Name and Position | Vanessa Diana Vigil (BUSINESS OFFICE 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 559 Santo Domingo Pueblo NM 87052-0559 Ph: (505) 465-3060 | Kewa Pueblo Health Corporation 85 W Highway 22 Santo Domingo NM 87052-0340 Ph: (505) 465-3060 |
| NPI Number | 1558648709 |
|---|---|
| Provider Enumeration Date | 11/15/2011 |
| Last Update Date | 11/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558648709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |