Organization
TOHATCHI AREA OF OPPORTUNITY & SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBER CROWE (CHIEF EXECUTIVE OFFICER)
(505) 722-9287
Entity
Organization
Contact information
Practice address
1658 S SECOND ST, GALLUP, NM 87301-5817
(505) 722-9287
(505) 722-9189
Mailing address
PO BOX 49, TOHATCHI, NM 87325-0049
(505) 722-9287
(505) 722-9189
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D1703
—
NM
Enumeration date
12/31/2018
Last updated
12/31/2018
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