Provider Demographics
NPI:1386129112
Name:TRILOGY NEW MEXICO, LLC
Entity type:Organization
Organization Name:TRILOGY NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GUARDIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:STAFFORD
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-239-1281
Mailing Address - Street 1:206 SOONER ST
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-5300
Mailing Address - Country:US
Mailing Address - Phone:806-239-1281
Mailing Address - Fax:575-208-7235
Practice Address - Street 1:1096 MECHEM DR STE 201
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7068
Practice Address - Country:US
Practice Address - Phone:806-239-1281
Practice Address - Fax:575-208-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management