1053460683 NPI number — NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED EARLY CHILDHOOD

Table of content: (NPI 1053460683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053460683 NPI number — NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED EARLY CHILDHOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED EARLY CHILDHOOD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053460683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 N WHITE SANDS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310-6246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-437-3505
Provider Business Mailing Address Fax Number:
575-439-4406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 TRUMAN ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-268-9506
Provider Business Practice Location Address Fax Number:
505-268-8187
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
JULIANNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAID COORDINATOR
Authorized Official Telephone Number:
575-437-3505

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34875077 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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