Organization
DISMAS HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES GIVENS (COMMUNITY SERVICE WORKER)
(505) 343-0746
Entity
Organization
Contact information
Practice address
701 CANDELARIA, ALBUQUERQUE, NM 87108
(505) 343-0746
(505) 345-4513
Mailing address
PO BOX 6101, ALBUQUERQUE, NM 87197-6101
(505) 343-0746
(505) 345-4513
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
NPI#1902918055
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N3938
—
NM
Enumeration date
07/02/2015
Last updated
07/02/2015
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