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General NPI Number Information
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NPI Number | 1306068895
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Entity Type | Organization
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Legal Business Name | CRISIS CENTER OF NNM
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 577 EL LLANO RD
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City | ESPANOLA
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State | NM
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Zip | 87532
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Country | US
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Telephone | 505-753-1656
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Fax | 505-753-7743
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Provider Business Mailing Address
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Address Line | 577 EL LLANO RD
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City | ESPANOLA
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State | NM
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Zip | 87532
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Country | US
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Telephone | 505-753-1656
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Fax | 505-753-7743
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CAROL ANN MERRIWEATHER
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Credential |
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Telephone | 505-753-1656
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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 | 1271
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License Number State | NM
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