Organization
FREE INDEED
Active
Organization
FREE INDEED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ONECIMO MIRABAL (CHIEF EXECUTIVE OFFICER)
(505) 804-2899
Entity
Organization
Contact information
Practice address
3080 DESERT SAGE AVE SW, LOS LUNAS, NM 87031-6577
(505) 804-2899
Mailing address
3080 DESERT SAGE AVE SW, LOS LUNAS, NM 87031-6577
(505) 804-2899
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/13/2024
Last updated
01/31/2025
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