Healthcare Provider Details

I. General information

NPI: 1134968944
Provider Name (Legal Business Name): NORTH CENTRAL NEW MEXICO ECONOMIC DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 DON GASPAR AVE
SANTA FE NM
87505-2666
US

IV. Provider business mailing address

644 DON GASPAR AVE
SANTA FE NM
87505-2666
US

V. Phone/Fax

Practice location:
  • Phone: 505-787-3774
  • Fax:
Mailing address:
  • Phone: 505-395-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MARTINEZ
Title or Position: SPECIAL PROJECTS MANAGER
Credential:
Phone: 505-356-9402