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General NPI Number Information
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NPI Number | 1194924928
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Entity Type | Organization
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Legal Business Name | RIO GRANDE ALCOHOLISM TREATMENT CENTER INCORPORATED
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 03/09/2025
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Provider Practice Location Address
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Address Line | 105 PASEO DEL CANON W STE A
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City | TAOS
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State | NM
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Zip | 87571-6943
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Country | US
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Telephone | 575-737-5533
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Fax | 575-737-5534
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Provider Business Mailing Address
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Address Line | 105 PASEO DEL CANON W STE A
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City | TAOS
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State | NM
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Zip | 87571-6943
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Country | US
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Telephone | 575-737-5533
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Fax | 575-737-5534
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LAWRENCE MEDINA
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Credential |
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Telephone | 575-737-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 5517
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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