Healthcare Provider Details

I. General information

NPI: 1992809388
Provider Name (Legal Business Name): ZUNI ENTREPRENEURIAL ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 208 B AVENUE
ZUNI NM
87327-0989
US

IV. Provider business mailing address

PO BOX 989
ZUNI NM
87327-0989
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5798
  • Fax: 505-782-2585
Mailing address:
  • Phone: 505-782-5798
  • Fax: 505-782-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2481PRF2006
License Number StateNM

VIII. Authorized Official

Name: MR. LARRY EUGENE ALFLEN
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 505-782-5798