| NPI | 1669736856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH KRISS GOODROW President/Owner 505-239-7459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 78151) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |