| NPI | 1194954370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY WHITE EAGLE Owner 505-255-1804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 005998) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2009-07-08 |