| NPI | 1639553928 |
|---|---|
| Doing Business As | CENTENNIAL SCHOOL BASE |
| Entity Type | Organization |
| Authorized Contact | VIRGIL MEDINA CEO 575-526-1105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2021-05-13 |