Healthcare Provider Details

I. General information

NPI: 1831938588
Provider Name (Legal Business Name): NORTH CENTRAL NEW MEXICO ECONOMIC DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
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: 505-787-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH REYNOLDS
Title or Position: SPECIAL PROJECTS MANAGER
Credential:
Phone: 505-787-3774