| NPI | 1285921569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY B JACKSON Executive Director 505-268-5295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NM 105341) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |