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General NPI Number Information
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NPI Number | 1346748282
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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 | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 311 WAR BONNET DRIVE
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City | MESCALERO
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State | NM
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Zip | 88340
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Country | US
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Telephone | 575-464-4301
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Fax | 575-464-3404
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Provider Business Mailing Address
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Address Line | PO BOX 227
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City | MESCALERO
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State | NM
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Zip | 88340-0227
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Country | US
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Telephone | 575-464-4301
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Fax | 575-464-3404
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOELLYN PAULINE MAGOOSH
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Credential |
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Telephone | 575-464-9274
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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 |
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License Number State |
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