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General NPI Number Information
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NPI Number | 1528185899
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Entity Type | Organization
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Legal Business Name | ABRAZOS FAMILY SUPPORT SERVICES
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 412 CAMINO DON TOMAS
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City | BERNALILLO
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State | NM
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Zip | 87004-9101
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Country | US
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Telephone | 505-867-3396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 788
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City | BERNALILLO
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State | NM
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Zip | 87004-0788
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Country | US
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Telephone | 505-867-3396
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. NORMAN SEGEL
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Credential | M.A.
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Telephone | 505-867-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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