| NPI | 1134260904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCIE FURGANG Program Operations Director 505-925-4080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: NM 6005) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: NM 6005) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |