Healthcare Provider Details

I. General information

NPI: 1215172887
Provider Name (Legal Business Name): CENTER OF PROTECTIVE ENVIRONMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1204 MECHEM DR SUITE 11
RUIDOSO NM
88345-7213
US

IV. Provider business mailing address

909 S FLORIDA AVE
ALAMOGORDO NM
88310-5307
US

V. Phone/Fax

Practice location:
  • Phone: 575-258-4946
  • Fax: 575-258-4949
Mailing address:
  • Phone: 575-434-3622
  • Fax: 575-434-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAY GOMOLAK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-434-3622