Organization
RIO GRANDE ALCOHOLISM TREATMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE A MEDINA MBA (EXECUTIVE DIRECTOR)
(505) 579-4253
Entity
Organization
Contact information
Practice address
2301 7TH ST, LAS VEGAS, NM 87701-4966
(505) 579-4253
Mailing address
2301 7TH ST, LAS VEGAS, NM 87701-4966
(505) 579-4253
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YA0400X
NM
251S00000X
Community/Behavioral Health Agency
1754
NM
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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