| NPI | 1023413788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAHLIA RAINBOLT Owner 505-989-3340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 1308) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2014-10-23 |