Provider Demographics
NPI:1316317639
Name:NEW MEXICO FOUNDATION FOR INDIVIDUALS WITH DISABILITIES
Entity type:Organization
Organization Name:NEW MEXICO FOUNDATION FOR INDIVIDUALS WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:FOUNDER
Authorized Official - Phone:505-850-2706
Mailing Address - Street 1:1270 MIRADOR LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5326
Mailing Address - Country:US
Mailing Address - Phone:505-850-2706
Mailing Address - Fax:
Practice Address - Street 1:1270 MIRADOR LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5326
Practice Address - Country:US
Practice Address - Phone:505-850-2706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No385H00000XRespite Care FacilityRespite Care