| NPI | 1033716972 |
|---|---|
| Other Name | FOUR CORNERS DETOX RECOVERY |
| Entity Type | Organization |
| Authorized Contact | LOU DURAN Credentialing And Billing 505-270-3966 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2023-11-25 |