| NPI | 1619269446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD ANTHONY GIBBS Pastor/Director 575-915-0450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |