Organization
JICARILLA APACHE NATION
Active
Other names
Jicarilla Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEVI PESATA (PRESIDENT)
(505) 759-3242
Entity
Organization
Contact information
Practice address
109 SENECA DRIVE, DULCE, NM 87528
(505) 759-3162
(505) 759-3588
Mailing address
PO BOX 546, DULCE, NM 87528-0546
(505) 759-3162
(505) 759-3588
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/07/2007
Last updated
09/07/2007
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