Provider Demographics
NPI:1992809388
Name:ZUNI ENTREPRENEURIAL ENTERPRISES
Entity type:Organization
Organization Name:ZUNI ENTREPRENEURIAL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ALFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-782-5798
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0989
Mailing Address - Country:US
Mailing Address - Phone:505-782-5798
Mailing Address - Fax:505-782-2585
Practice Address - Street 1:BUILDING 208 B AVENUE
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327-0989
Practice Address - Country:US
Practice Address - Phone:505-782-5798
Practice Address - Fax:505-782-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2481PRF2006251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7518Medicaid
NMD1187Medicaid