Provider Demographics
NPI:1063643237
Name:MCKINLEY COUNTY
Entity Type:Organization
Organization Name:MCKINLEY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-863-1400
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-0070
Mailing Address - Country:US
Mailing Address - Phone:505-863-1400
Mailing Address - Fax:
Practice Address - Street 1:207 W HILL AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4615
Practice Address - Country:US
Practice Address - Phone:505-863-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency