Provider Demographics
NPI:1285834150
Name:MESCALERO TRIBAL HUMAN SERVICES
Entity Type:Organization
Organization Name:MESCALERO TRIBAL HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:505-464-4338
Mailing Address - Street 1:107 SUNSET LOOP
Mailing Address - Street 2:P.O. BOX 228
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340
Mailing Address - Country:US
Mailing Address - Phone:505-464-4330
Mailing Address - Fax:505-464-4331
Practice Address - Street 1:107 SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340
Practice Address - Country:US
Practice Address - Phone:505-464-4330
Practice Address - Fax:505-464-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORNM600999OtherVALUEOPTIONS
NM33555567Medicaid