Healthcare Provider Details

I. General information

NPI: 1750470415
Provider Name (Legal Business Name): LEADERS INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W DUNNAM ST
HOBBS NM
88240-6020
US

IV. Provider business mailing address

115 W DUNNAM ST
HOBBS NM
88240-6020
US

V. Phone/Fax

Practice location:
  • Phone: 505-393-8201
  • Fax: 505-393-1318
Mailing address:
  • Phone: 505-393-8201
  • Fax: 505-393-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number02143726002
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02143726002
License Number StateNM

VIII. Authorized Official

Name: MR. RUSTY BAXTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-393-8201