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General NPI Number Information
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NPI Number | 1245777523
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Entity Type | Organization
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Legal Business Name | SHARED VISION
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 54 CUT TREE LN
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City | BELEN
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State | NM
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Zip | 87002-8224
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Country | US
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Telephone | 505-306-9136
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Fax |
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Provider Business Mailing Address
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Address Line | 54 CUT TREE LN
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City | BELEN
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State | NM
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Zip | 87002-8224
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Country | US
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Telephone | 505-306-9136
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN KARY SANCHEZ
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Credential | MSW
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Telephone | 505-306-9136
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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 | C0938
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License Number State | NM
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