Provider Demographics
NPI:1104132976
Name:MORA COLFAX HEAD START
Entity type:Organization
Organization Name:MORA COLFAX HEAD START
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBINS-MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-387-3146
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:HOLMAN
Mailing Address - State:NM
Mailing Address - Zip Code:87723
Mailing Address - Country:US
Mailing Address - Phone:575-387-3146
Mailing Address - Fax:575-387-6656
Practice Address - Street 1:3549 STATE HWY 518
Practice Address - Street 2:
Practice Address - City:HOLMAN
Practice Address - State:NM
Practice Address - Zip Code:87723
Practice Address - Country:US
Practice Address - Phone:575-387-3146
Practice Address - Fax:575-387-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management