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General NPI Number Information
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NPI Number | 1649310749
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Entity Type | Organization
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Legal Business Name | TAOS GROUP HOME, INC.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 314 DON FERNANDO ST POB 2360
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City | TAOS
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State | NM
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Zip | 87571-5953
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Country | US
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Telephone | 575-751-7037
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Fax | 575-751-3010
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Provider Business Mailing Address
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Address Line | 314 DON FERNANDO ST
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City | TAOS
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State | NM
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Zip | 87571-5953
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Country | US
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Telephone | 575-751-7037
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Fax | 575-751-3010
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. JOHN ANTHONY DEPAULA
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Credential |
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Telephone | 505-751-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 0752
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License Number State | NM
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