NPI | 1407209364 |
---|---|
Entity Type | Organization |
Authorized Contact | JEREMIAH DYE CEO 505-241-5182 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
Enumeration Date | 2016-07-15 |
Last Update Date | 2024-10-17 |