| NPI | 1194077396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN M HAYNES Owner 505-238-9551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM I-05833) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2025-02-20 |