| NPI | 1790179844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY ANNE FORBES Program Director 505-692-5034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children (Licence: NM X-08906) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2017-04-26 |