Healthcare Provider Details

I. General information

NPI: 1306318423
Provider Name (Legal Business Name): TOHATCHI AREA OF OPPORTUNITY & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 S SECOND ST
GALLUP NM
87301-5817
US

IV. Provider business mailing address

PO BOX 49
TOHATCHI NM
87325-0049
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9287
  • Fax: 505-722-9189
Mailing address:
  • Phone: 505-722-9287
  • Fax: 505-722-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KIMBER CROWE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-722-9287