| NPI | 1548452949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED GONZALES Board President 575-758-3879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NM CU00010276) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M06217) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2008-08-20 |