| NPI | 1376336974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL RAY GURULE CFO 505-465-3079 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-09-05 |