Healthcare Provider Details

I. General information

NPI: 1144754656
Provider Name (Legal Business Name): EIGHT NORTHERN INDIAN PUEBLOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SAN PEDRO DR NE STE 220
ALBUQUERQUE NM
87110-4133
US

IV. Provider business mailing address

PO BOX 969 327 EAGLE DRIVE
OHKAY OWINGEH NM
87566-0969
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-3152
  • Fax:
Mailing address:
  • Phone: 575-751-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DOROTHY ANNE FORBES
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 505-692-5034