Organization
NM DEPARTMENT OF HEALTH
Active
Parent organization
NM DEPARTMENT OF HEALTH
Other names
Ft Bayary Medical Centter, Yucca Lodge
Organization subpart
Yes
Provider details
NPI number
Legal business name
NM DEPARTMENT OF HEALTH
Authorized official
MR. ALFRED CORONA CHAVEZ LADAC, B.S. (CLINICAL SUPERVISOR)
(575) 537-8831
Entity
Organization
Contact information
Practice address
100 CALLE DE CENTRAL, FORT BAYARD, NM 88036
(575) 537-8831
(575) 537-8886
Mailing address
PO BOX 36216, FORT BAYARD, NM 88036-6216
(575) 537-8831
(575) 537-8886
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
5610
NM
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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