Healthcare Provider Details

I. General information

NPI: 1588942429
Provider Name (Legal Business Name): SNMCAC HEAD START
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 GAGE
ARTESIA NM
88210
US

IV. Provider business mailing address

PO BOX 37
ARTESIA NM
88210-0037
US

V. Phone/Fax

Practice location:
  • Phone: 575-748-1141
  • Fax: 575-748-9024
Mailing address:
  • Phone: 575-748-1141
  • Fax: 575-748-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number94581
License Number StateNM

VIII. Authorized Official

Name: MRS. LINDA LEE PASCOE
Title or Position: HEALTH/NUTRITION MANAGER
Credential:
Phone: 575-748-1141