Edventuresgroup | |
8 Hawk Circle Edventures C/o Thoreau Middle School Thoreau NM 87323 | |
(801) 833-0568 | |
(801) 930-9134 |
Full Name | Edventuresgroup |
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Speciality | Community/behavioral Health |
Location | 8 Hawk Circle, Thoreau, New Mexico |
Authorized Official Name and Position | Siamak Khadjenoury (CEO) |
Authorized Official Contact | 8018330568 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Edventuresgroup 8 Hawk Circle Thoreau Middle School Thoreau NM 84732 Ph: (801) 833-0568 | Edventuresgroup 8 Hawk Circle Edventures C/o Thoreau Middle School Thoreau NM 87323 Ph: (801) 833-0568 |
NPI Number | 1861773004 |
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Provider Enumeration Date | 09/01/2011 |
Last Update Date | 09/01/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861773004 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |