Healthcare Provider Details

I. General information

NPI: 1871615583
Provider Name (Legal Business Name): MEND INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 RIO ST
RUIDOSO NM
88345-7401
US

IV. Provider business mailing address

PO BOX 362
RUIDOSO NM
88355-0362
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-4672
  • Fax: 505-257-4762
Mailing address:
  • Phone: 505-257-4672
  • Fax: 505-257-4762

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: MS. VICKY LYNN LOZANO
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-257-4672