| NPI | 1265024103 |
|---|---|
| Former Legal Business Name | AVALON RANCH |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SUSAN ROGGE-ROGERS Executive Director 575-302-8304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-02-10 |