| NPI | 1922520162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLE A GRADY Sole Proprieter 575-202-7576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 1944) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2017-07-10 |