| NPI | 1073835963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD GENE KRUIS Owner/Provider 575-650-0071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 03-130243-00-2) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2010-02-19 |