Provider Demographics
NPI:1083771760
Name:LA FAMILIA, INC.
Entity Type:Organization
Organization Name:LA FAMILIA, INC.
Other - Org Name:LA FAMILIA-NAMASTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-918-4367
Mailing Address - Street 1:2400 WELLESLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1812
Mailing Address - Country:US
Mailing Address - Phone:505-766-9361
Mailing Address - Fax:505-243-2252
Practice Address - Street 1:2400 WELLESLEY DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1812
Practice Address - Country:US
Practice Address - Phone:505-766-9361
Practice Address - Fax:505-243-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP6125Medicaid
NMM0892Medicaid
NMQ0475Medicaid