Healthcare Provider Details

I. General information

NPI: 1285834150
Provider Name (Legal Business Name): MESCALERO TRIBAL HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SUNSET LOOP
MESCALERO NM
88340
US

IV. Provider business mailing address

107 SUNSET LOOP P.O. BOX 228
MESCALERO NM
88340
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-4330
  • Fax: 505-464-4331
Mailing address:
  • Phone: 505-464-4330
  • Fax: 505-464-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA LAYTON
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, NCC
Phone: 505-464-4338