| 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 |