Healthcare Provider Details

I. General information

NPI: 1871862326
Provider Name (Legal Business Name): NEW MEXICO FOUNDATION FOR INDIVIDUALS WITH DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N HILL RD
BERNALILLO NM
87004-5926
US

IV. Provider business mailing address

501 N HILL RD
BERNALILLO NM
87004-5926
US

V. Phone/Fax

Practice location:
  • Phone: 505-850-2706
  • Fax:
Mailing address:
  • Phone: 505-850-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAUDIA CLAY
Title or Position: CHAIR/FOUNDER
Credential:
Phone: 505-850-2706