Organization
NEW VISION GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN BAKER (CO-OWNER)
(505) 769-2142
Entity
Organization
Contact information
Practice address
919 RENCHER ST, CLOVIS, NM 88101-5858
(505) 769-2142
(505) 769-2161
Mailing address
919 RENCHER ST, CLOVIS, NM 88101-5858
(505) 769-2142
(505) 769-2161
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04937261
—
NM
Enumeration date
03/23/2007
Last updated
08/22/2020
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