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General NPI Number Information
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NPI Number | 1306318423
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Entity Type | Organization
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Legal Business Name | TOHATCHI AREA OF OPPORTUNITY & SERVICES
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 1658 S SECOND ST
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City | GALLUP
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State | NM
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Zip | 87301-5817
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Country | US
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Telephone | 505-722-9287
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Fax | 505-722-9189
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Provider Business Mailing Address
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Address Line | PO BOX 49
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City | TOHATCHI
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State | NM
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Zip | 87325-0049
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Country | US
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Telephone | 505-722-9287
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Fax | 505-722-9189
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KIMBER CROWE
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Credential |
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Telephone | 505-722-9287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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