| NPI | 1801602909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MORENUS Manager 505-620-5504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2025-01-02 |