| NPI | 1861808800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY MARTINEZ Owner/Provider 505-410-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 005695) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2014-07-10 |