| NPI | 1225361868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE COHEN Fis Ii 505-877-7060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 101Y00000X) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-09-15 |