| NPI | 1861949943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY GLICKMAN Owner 575-590-4690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0125451) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2016-09-06 |