| NPI | 1255636221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVIN D PARKER Co Owner 505-720-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NM 03159603007) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |