Provider Demographics
NPI:1053460683
Name:NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED EARLY CHILDHOOD
Entity Type:Organization
Organization Name:NEW MEXICO SCHOOL FOR THE BLIND AND VISUALLY IMPAIRED EARLY CHILDHOOD
Other - Org Name:NEW MEXICO SCHOOL FOR THE VISUALLY HANDICAPPED EARLY CHILDHOOD PROGRAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-437-3505
Mailing Address - Street 1:1900 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6246
Mailing Address - Country:US
Mailing Address - Phone:575-437-3505
Mailing Address - Fax:575-439-4406
Practice Address - Street 1:230 TRUMAN ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1333
Practice Address - Country:US
Practice Address - Phone:505-268-9506
Practice Address - Fax:505-268-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251300000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34875077Medicaid