| NPI | 1609382910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE BOBO Member 505-702-1061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2017-12-21 |