Organization
ONYX SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN D PARKER (CO-OWNER)
(505) 720-2273
Entity
Organization
Contact information
Practice address
5301 CROOKED CREEK AVE NW, ALBUQUERQUE, NM 87114-4193
(505) 792-1996
(505) 899-8251
Mailing address
708 SANDY DR NW, ALBUQUERQUE, NM 87120-3211
(505) 720-2273
(505) 831-8090
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
03159603007
NM
Other
Enumeration date
01/21/2011
Last updated
01/21/2011
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