Provider Demographics
NPI:1063844363
Name:AMISTAD Y RESOLANA
Entity Type:Organization
Organization Name:AMISTAD Y RESOLANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-617-5846
Mailing Address - Street 1:713 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4532
Mailing Address - Country:US
Mailing Address - Phone:505-617-5846
Mailing Address - Fax:505-454-7198
Practice Address - Street 1:713 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4532
Practice Address - Country:US
Practice Address - Phone:505-617-5846
Practice Address - Fax:505-454-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3730251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health