| NPI | 1285801191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL BLACKWOOD Director 505-242-6988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2018-12-10 |