| NPI | 1295870020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCE SMITH Director 505-332-6814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: NM 5025) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2021-06-04 |