1366258386 NPI number — ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC

Table of content: (NPI 1366258386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366258386 NPI number — ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC
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:
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:
1366258386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87193-5264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-585-1348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7809 RIDGEVIEW DR NW
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:
87120-2880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-585-1378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
575-707-8150

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com