Organization
RAVENSNOW L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORKY ST. JAMES L.L.C. (PRESIDENT)
(505) 830-6030
Entity
Organization
Contact information
Practice address
3150 CARLISLE BLVD NE, STE 22, ALBUQUERQUE, NM 87110-1679
(505) 830-6030
(505) 830-6031
Mailing address
3150 CARLISLE BLVD NE, STE 22, ALBUQUERQUE, NM 87110-1679
(505) 830-6030
(505) 830-6031
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3888
NM
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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