Healthcare Provider Details

I. General information

NPI: 1013155738
Provider Name (Legal Business Name): THE COMMUNITY FOUNDATION OF SOUTHERN NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 28 GADSDEN HIGH SCHOOL-BASED HEALTH CENTER
ANTHONY NM
88021
US

IV. Provider business mailing address

301 S CHURCH ST STE H
LAS CRUCES NM
88001-3547
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6300
  • Fax: 575-882-2370
Mailing address:
  • Phone: 575-521-4794
  • Fax: 575-521-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA SOLUM
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 575-521-4794