Provider Demographics
NPI:1215172887
Name:CENTER OF PROTECTIVE ENVIRONMENT, INC.
Entity type:Organization
Organization Name:CENTER OF PROTECTIVE ENVIRONMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-434-3622
Mailing Address - Street 1:909 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5307
Mailing Address - Country:US
Mailing Address - Phone:575-434-3622
Mailing Address - Fax:575-434-3530
Practice Address - Street 1:1204 MECHEM DR
Practice Address - Street 2:SUITE 11
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7213
Practice Address - Country:US
Practice Address - Phone:575-258-4946
Practice Address - Fax:575-258-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable