Organization
COYOTE CANYON REHABILITATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MACDONALD AVERY (EXECUTIVE DIRECTOR)
(505) 735-2002
Entity
Organization
Contact information
Practice address
10 MILES EAST NAVAJO ROUTE #9, BRIMHALL, NM 87310
(505) 735-2261
(505) 735-2013
Mailing address
PO BOX 158, BRIMHALL, NM 87310-0158
(505) 735-2261
(505) 735-2013
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D2167
—
NM
Enumeration date
04/28/2011
Last updated
04/28/2011
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