| NPI | 1174768311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S SIMPSON Program Director 505-977-9180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2008-12-02 |