| NPI | 1558644161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE A. MEDINA Executive Director 505-579-4253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 101YA0400X) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |