| NPI | 1992140305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE A MEDINA Executive Director 505-579-4253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 101YA0400X) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NM 1754) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |