Provider Demographics
NPI:1245804301
Name:MESCALERO APACHE TRIBE
Entity Type:Organization
Organization Name:MESCALERO APACHE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:575-464-4432
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0228
Mailing Address - Country:US
Mailing Address - Phone:575-464-4432
Mailing Address - Fax:575-464-4331
Practice Address - Street 1:107 SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-8834
Practice Address - Country:US
Practice Address - Phone:575-464-4432
Practice Address - Fax:575-464-4331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MESCALERO TRIBAL HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33555567Medicaid