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 |