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General NPI Number Information
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NPI Number | 1023818176
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Entity Type | Organization
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Legal Business Name | INSIDE OUT
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 908 N RIVERSIDE DR STE 6
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City | ESPANOLA
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State | NM
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Zip | 87532-2916
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Country | US
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Telephone | 505-367-3500
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Fax | 505-367-3503
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Provider Business Mailing Address
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Address Line | 908 N RIVERSIDE DR STE 6
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City | ESPANOLA
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State | NM
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Zip | 87532-2916
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Country | US
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Telephone | 505-367-3500
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Fax | 505-367-3503
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BERNADETTE GUTIERREZ
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Credential | CPSW, CCSS, CHW
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Telephone | 505-367-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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