Provider Demographics
NPI:1154475317
Name:RED MOUNTAIN FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:RED MOUNTAIN FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:505-994-0364
Mailing Address - Street 1:2001 SPRING DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2483
Mailing Address - Country:US
Mailing Address - Phone:505-994-0364
Mailing Address - Fax:505-994-0384
Practice Address - Street 1:2001 SPRING DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2483
Practice Address - Country:US
Practice Address - Phone:505-994-0364
Practice Address - Fax:505-994-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4423103TF0000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12280887Medicaid