Healthcare Provider Details

I. General information

NPI: 1306068895
Provider Name (Legal Business Name): CRISIS CENTER OF NNM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 EL LLANO RD
ESPANOLA NM
87532
US

IV. Provider business mailing address

577 EL LLANO RD
ESPANOLA NM
87532
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-1656
  • Fax: 505-753-7743
Mailing address:
  • Phone: 505-753-1656
  • Fax: 505-753-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1271
License Number StateNM

VIII. Authorized Official

Name: MS. CAROL ANN MERRIWEATHER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-753-1656