| NPI | 1982372223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT J POEL Owner 505-246-6971 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-05-13 |