Healthcare Provider Details

I. General information

NPI: 1376695387
Provider Name (Legal Business Name): TAOS COUNTY ARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SALAZAR RD
TAOS NM
87571
US

IV. Provider business mailing address

1030 SALAZAR RD
TAOS NM
87571
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-4274
  • Fax: 505-758-1680
Mailing address:
  • Phone: 505-758-4274
  • Fax: 505-758-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE R RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-758-4274