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General NPI Number Information
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NPI Number | 1023999539
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Entity Type | Organization
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Legal Business Name | MERIDIAN COMMUNITY CARE LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 96 HOMESTEADS RD
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City | PLACITAS
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State | NM
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Zip | 87043-9230
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Country | US
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Telephone | 505-333-8503
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 670
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City | PLACITAS
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State | NM
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Zip | 87043-0670
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Country | US
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Telephone | 505-333-8503
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Fax |
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Authorized Official
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Title or Position | CEO & CO-FOUNDER
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Name | KRISTIN KOTKOWSKI
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Credential |
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Telephone | 505-333-8503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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