Organization
MASADA HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA B RILEY BS LADAC (EXECUTIVE DIRECTOR)
(505) 325-9205
Entity
Organization
Contact information
Practice address
610 N DUSTIN AVE, FARMINGTON, NM 87401
(505) 325-9205
(505) 325-9216
Mailing address
610 N DUSTIN AVE, FARMINGTON, NM 87401
(505) 325-9205
(505) 325-9216
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0154441
NM
Other
Enumeration date
02/10/2015
Last updated
02/10/2015
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