Organization
TRANSITIONAL LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY B JACKSON (EXECUTIVE DIRECTOR)
(505) 268-5295
Entity
Organization
Contact information
Practice address
5601 DOMINGO RD NE, ALBUQUERQUE, NM 87108-1610
(505) 268-5295
Mailing address
5601 DOMINGO RD NE, ALBUQUERQUE, NM 87108-1610
(505) 268-5295
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
105341
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B9311
—
NM
Enumeration date
07/07/2011
Last updated
07/07/2011
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