Healthcare Provider Details

I. General information

NPI: 1861895633
Provider Name (Legal Business Name): HABITAT FOR HUMANITY OF TAOS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ALEXANDER ST SUITE E
TAOS NM
87571-6944
US

IV. Provider business mailing address

PO BOX 1888
TAOS NM
87571-1888
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-7827
  • Fax: 575-758-0715
Mailing address:
  • Phone: 575-758-7827
  • Fax: 575-758-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number88824
License Number StateNM

VIII. Authorized Official

Name: MS. CYNTHIA ARVIDSON
Title or Position: EXECUTIVE DIRECTOR
Credential: E.D.
Phone: 575-758-7827