Organization
LAGUNA EARLY CHILDHOOD PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE E BOLES (DIRECTOR DIVISION OF EARLY CHILDHOO)
(505) 552-1013
Entity
Organization
Contact information
Practice address
I40 W 114 BLDG 1125, LAGUNA, NM 87026
(505) 552-1013
(505) 552-9569
Mailing address
P.O. BOX 207, 1-40 W EXIT 114 BLDG 1125, LAGUNA, NM 87026
(505) 552-1013
(505) 552-9569
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E7009
—
NM
Enumeration date
09/14/2016
Last updated
09/14/2016
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