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General NPI Number Information
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NPI Number | 1386129112
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Entity Type | Organization
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Legal Business Name | TRILOGY NEW MEXICO, LLC
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 1096 MECHEM DR STE 201
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City | RUIDOSO
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State | NM
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Zip | 88345-7068
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Country | US
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Telephone | 806-239-1281
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Fax | 575-208-7235
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Provider Business Mailing Address
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Address Line | 206 SOONER ST
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City | WOLFFORTH
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State | TX
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Zip | 79382-5300
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Country | US
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Telephone | 806-239-1281
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Fax | 575-208-7235
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Authorized Official
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Title or Position | OWNER/GUARDIAN
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Name | MS. BRENDA STAFFORD BAKER
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Credential | RN
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Telephone | 806-239-1281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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