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General NPI Number Information
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NPI Number | 1356690804
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Entity Type | Organization
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Legal Business Name | GENO HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 3560 SHILOH RD. NE
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City | RIO RANCHO
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State | NM
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Zip | 87144
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Country | US
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Telephone | 505-891-3573
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Fax | 505-891-3573
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Provider Business Mailing Address
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Address Line | 3560 SHILOH RD. NE
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City | RIO RANCHO
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State | NM
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Zip | 87144
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Country | US
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Telephone | 505-891-3573
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Fax | 505-891-3573
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GEORGE ASHU NOJANG
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Credential |
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Telephone | 505-891-3573
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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 | 12-00012932
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License Number State | NM
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