Organization
COMPOSTELA COMMUNITY AND FAMILY CULTURAL INSTITUTE
Active
Other names
CC&FCI
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRINIDAD DE JESUS ARGUELLO PH.D.,LISW, PMHBC-RN (CEO)
(575) 776-2752
Entity
Organization
Contact information
Practice address
1021 SALAZAR RD, TAOS, NM 87571-8233
(575) 613-2008
Mailing address
PO BOX 2173, EL PRADO, NM 87529-2173
(575) 776-2752
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
R12314
NM
251S00000X
Community/Behavioral Health Agency
Primary
12732
NM
251X00000X
Supports Brokerage Agency
R12314
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163W00000X
REGISTERED NURSE R12314
NM
01
—
1841242336
NPI
NM
01
—
343511902
MEDICARE
NM
05
—
H6196
—
NM
05
—
MHC51409
—
NM
Enumeration date
09/11/2015
Last updated
09/14/2015
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