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General NPI Number Information
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NPI Number | 1851823553
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Entity Type | Organization
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Legal Business Name | 48NEW MEXICO TREATMENT SERVICES
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 607 E APACHE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-6925
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Country | US
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Telephone | 505-326-2012
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Fax | 505-326-2939
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Provider Business Mailing Address
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Address Line | 2201 E 11TH ST # SR
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City | FARMINGTON
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State | NM
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Zip | 87401-7570
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Country | US
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Telephone | 505-326-2012
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Fax | 505-326-2939
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | LUCRECIA BENALLY
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Credential | BSW, LSAA
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Telephone | 505-326-2012
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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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