| NPI | 1164940599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN MADELEINE MANZ Owner 505-716-7995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 0101581) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2020-03-03 |