# JICARILLA HEALTH CARE FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003820069
- **Authorized official:** MR. THOMAS T PRYOR RN (PUBLIC HEALTH NURSE)
- **Authorized official phone:** (505) 759-7286

## Contact information

- **Practice address:** 12000 STONE LAKE RD, DULCE, NM 87528
- **Practice address phone:** (505) 759-7286
- **Mailing address:** PO BOX 1144, PAGOSA SPRINGS, CO 81147-1144

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | OR | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 08/22/2020