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General NPI Number Information
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NPI Number | 1245804301
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Entity Type | Organization
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Legal Business Name | MESCALERO APACHE TRIBE
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 107 SUNSET LOOP
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City | MESCALERO
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State | NM
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Zip | 88340-8834
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Country | US
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Telephone | 575-464-4432
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Fax | 575-464-4331
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Provider Business Mailing Address
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Address Line | PO BOX 228
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City | MESCALERO
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State | NM
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Zip | 88340-0228
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Country | US
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Telephone | 575-464-4432
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Fax | 575-464-4331
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Authorized Official
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Title or Position | DIRECTOR
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Name | VERALYN MENDEZ
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Credential | MSW
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Telephone | 575-464-4432
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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 |
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License Number State |
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