Organization
RIO GRANDE ALCOHOLISM TREATMENT PROGRAM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE A. MEDINA MBA (EXECUTIVE DIRECTOR)
(505) 579-4253
Entity
Organization
Contact information
Practice address
225 GRAND AVE, LAS VEGAS, NM 87701-3832
(505) 454-9611
Mailing address
PO BOX 310, EMBUDO, NM 87531-0310
(505) 579-4253
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YA0400X
NM
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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