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 |