| NPI | 1679007744 |
|---|---|
| Doing Business As | NEW MOON LODGE |
| Entity Type | Organization |
| Authorized Contact | DOROTHY ANNE FORBES Program Director 505-692-5034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |