Organization
TAOS COUNTY ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE R RODRIGUEZ (EXECUTIVE DIRECTOR)
(505) 758-4274
Entity
Organization
Contact information
Practice address
1030 SALAZAR RD, TAOS, NM 87571
(505) 758-4274
(505) 758-1680
Mailing address
1030 SALAZAR RD, TAOS, NM 87571
(505) 758-4274
(505) 758-1680
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1065
MEDICAID & WAIVER
NM
01
—
E7255
MEDICAID EPSDT
NM
Enumeration date
01/18/2007
Last updated
08/22/2020
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