Organization
JICARILLA APACHE NATION
Active
Other names
Jicarilla Apache Nation Dialysis Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
TY VICENTI (PRESIDENT)
(575) 759-4201
Entity
Organization
Contact information
Practice address
450 N MUNDO DR., DULCE, NM 87528
(575) 759-4206
(575) 759-4471
Mailing address
450 N MUNDO DR., DULCE, NM 87528
(575) 759-4206
(575) 759-4471
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
09/19/2013
Last updated
05/20/2015
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