Provider Demographics
NPI:1306365929
Name:CALYX INSTITUTE LLC
Entity Type:Organization
Organization Name:CALYX INSTITUTE LLC
Other - Org Name:THE CALYX INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-652-7065
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-1194
Mailing Address - Country:US
Mailing Address - Phone:505-652-7065
Mailing Address - Fax:
Practice Address - Street 1:10701 LOMAS BLVD NE, STE. 101
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-379-3654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33188301Medicaid