Provider Demographics
NPI:1396104964
Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MORA VALLEY COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-387-5069
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:575-387-9011
Practice Address - Street 1:10 RANGER DR
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732
Practice Address - Country:US
Practice Address - Phone:575-387-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORA VALLEY COMMUNITY HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6333261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM048504Medicaid
NM048504Medicaid