Healthcare Provider Details

I. General information

NPI: 1932409497
Provider Name (Legal Business Name): REGION IX EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 SERVICE RD
RUIDOSO NM
88345-6063
US

IV. Provider business mailing address

237 SERVICE RD
RUIDOSO NM
88345-6063
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-2368
  • Fax: 575-257-2141
Mailing address:
  • Phone: 575-257-2368
  • Fax: 575-257-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: EVELYN SANCHEZ
Title or Position: MEDICAID TECHNICIAN
Credential:
Phone: 575-257-2368