| NPI | 1154980621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ALEXY Fiscal Operations Manager 505-866-9271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2019-06-10 |