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General NPI Number Information
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NPI Number | 1174071534
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Entity Type | Organization
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Legal Business Name | LAGUNA EARLY CHILDHOOD PROGRAM
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | I40 W 114 BLDG 1125
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City | LAGUNA
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State | NM
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Zip | 87026
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Country | US
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Telephone | 505-552-1013
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Fax | 505-552-9569
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Provider Business Mailing Address
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Address Line | P.O. BOX 207 1-40 W EXIT 114 BLDG 1125
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City | LAGUNA
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State | NM
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Zip | 87026
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Country | US
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Telephone | 505-552-1013
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Fax | 505-552-9569
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Authorized Official
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Title or Position | DIRECTOR DIVISION OF EARLY CHILDHOO
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Name | JUNE E BOLES
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Credential |
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Telephone | 505-552-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NM
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