| NPI | 1245469634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HUMBERTO IBARBO Director/Owner 505-507-3536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM 3668) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM LADAC 3668) |
| 251B00000X Case Management (Licence: NM LADAC 3668) | |
| 252Y00000X Early Intervention Provider Agency (Licence: NM LADAC 3668) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2016-08-04 |