| NPI | 1760121370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELONIE BACOCCINI Owner 505-362-0758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2026-06-26 |