Full Name | |
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Speciality | Community/behavioral Health |
Location | 109 Seneca Drive, Dulce, New Mexico |
Authorized Official Name and Position | Levi Pesata (PRESIDENT) |
Authorized Official Contact | 5057593242 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 546 Dulce NM 87528-0546 Ph: (505) 759-3162 | 109 Seneca Drive Dulce NM 87528 Ph: (505) 759-3162 |
NPI Number | 1508051061 |
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Provider Enumeration Date | 09/07/2007 |
Last Update Date | 09/07/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508051061 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |