Organization
COMMUNITY SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNALIZA GOURNEAU (EXECUTIVE DIRECTOR)
(575) 650-0132
Entity
Organization
Contact information
Practice address
12021 SKYLINE RD NE APT 2723, ALBUQUERQUE, NM 87123-3087
(575) 650-0132
Mailing address
12021 SKYLINE RD NE APT 2723, ALBUQUERQUE, NM 87123-3087
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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