Provider Demographics
NPI:1003568650
Name:RIO ARRIBA COUNTY
Entity Type:Organization
Organization Name:RIO ARRIBA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-747-1418
Mailing Address - Street 1:1122 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3453
Mailing Address - Country:US
Mailing Address - Phone:505-927-2157
Mailing Address - Fax:505-753-6557
Practice Address - Street 1:320 HUNTER ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3430
Practice Address - Country:US
Practice Address - Phone:505-753-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIO ARRIBA COUNTY HHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care