Organization
EIGHT NORTHERN INDIAN PUEBLOS
Active
Other names
New Moon Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOROTHY ANNE FORBES LCSW (PROGRAM DIRECTOR)
(505) 692-5034
Entity
Organization
Contact information
Practice address
579 WHITE SWAN RD, 327 EAGLE DRIVE, OHKAY OWINGEH, NM 87566
(505) 852-2788
Mailing address
PO BOX 969, 327 EAGLE DRIVE, OHKAY OWINGEH, NM 87566-0969
(575) 751-7688
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28585810
—
NM
Enumeration date
04/17/2017
Last updated
04/17/2017
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