Organization
CHILDREN'S COMMUNITY MENTAL HEALTH CLINIC
Active
Parent organization
BERNALILLO COUNTY JUVENILE DETENTION YOUTH SERVICES CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
BERNALILLO COUNTY JUVENILE DETENTION YOUTH SERVICES CENTER
Authorized official
MR. SOLOMON T FOULK M.S. (COMPREHENSIVE COMMUNITY SUPPORT SER)
(505) 342-3799
Entity
Organization
Contact information
Practice address
5100 2ND ST NW, ALBUQUERQUE, NM 87107-4009
(505) 342-3799
(505) 342-3758
Mailing address
5100 2ND ST NW, ALBUQUERQUE, NM 87107-4009
(505) 342-3799
(505) 342-3758
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
171M00000X
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VNM00719NO
—
NM
Enumeration date
08/29/2008
Last updated
08/29/2008
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