Basic Information
| Provider Information | |||||||||
| NPI: | 1720406903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZUNI RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 339 | ||||||||
| Address2: | |||||||||
| City: | ZUNI | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873270339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057824710 | ||||||||
| FaxNumber: | 5057825880 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 D AVENUE | ||||||||
| Address2: | BLACKROCK | ||||||||
| City: | ZUNI | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873270000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057824710 | ||||||||
| FaxNumber: | 5057825880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HANNAWEEKE | ||||||||
| AuthorizedOfficialFirstName: | AVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | TRIBAL ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5057827000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PUEBLO OF ZUNI | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.