Provider Demographics
NPI:1316252174
Name:WJS NEW MEXICO
Entity type:Organization
Organization Name:WJS NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NIKON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:778-899-3422
Mailing Address - Street 1:2205 MIGUEL CHAVEZ RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6914
Mailing Address - Country:US
Mailing Address - Phone:505-954-1093
Mailing Address - Fax:
Practice Address - Street 1:2205 MIGUEL CHAVEZ RD
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6914
Practice Address - Country:US
Practice Address - Phone:505-954-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care