| Mandala Group Inc. | |
|
19478 Highway 314 Belen NM 87002-8223 | |
| (505) 859-0814 | |
| Not Available |
| Full Name | Mandala Group Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 19478 Highway 314, Belen, New Mexico |
| Authorized Official Name and Position | Barbara J Smith (OWNER) |
| Authorized Official Contact | 5058590814 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandala Group Inc. Po Box 323 Jarales NM 87023-0323 Ph: (505) 859-0814 | Mandala Group Inc. 19478 Highway 314 Belen NM 87002-8223 Ph: (505) 859-0814 |
| NPI Number | 1376964841 |
|---|---|
| Provider Enumeration Date | 12/30/2013 |
| Last Update Date | 12/30/2013 |
| Medicare PECOS PAC ID | 6608192935 |
|---|---|
| Medicare Enrollment ID | O20150304002011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376964841 | NPI | - | NPPES |
| 70638 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2010081 (New Mexico) | Primary |
| Provider Name | Barbara J Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023222635 PECOS PAC ID: 8325364656 Enrollment ID: I20150304002089 |
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