| NPI | 1588074926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSA BACKSTROM Owner 505-699-9762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0141331) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2014-05-07 |