Provider Demographics
NPI:1851823553
Name:48NEW MEXICO TREATMENT SERVICES
Entity type:Organization
Organization Name:48NEW MEXICO TREATMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENALLY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, LSAA
Authorized Official - Phone:505-326-2012
Mailing Address - Street 1:2201 E 11TH ST # SR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-7570
Mailing Address - Country:US
Mailing Address - Phone:505-326-2012
Mailing Address - Fax:505-326-2939
Practice Address - Street 1:607 E APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6925
Practice Address - Country:US
Practice Address - Phone:505-326-2012
Practice Address - Fax:505-326-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health