Provider Demographics
NPI:1346238110
Name:OTERO COUNTY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
Entity Type:Organization
Organization Name:OTERO COUNTY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM
Other - Org Name:THE WRIGHT HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:LADAC
Authorized Official - Phone:505-437-8942
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-1561
Mailing Address - Country:US
Mailing Address - Phone:505-437-8942
Mailing Address - Fax:505-437-8980
Practice Address - Street 1:850 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7367
Practice Address - Country:US
Practice Address - Phone:505-437-8942
Practice Address - Fax:505-437-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5371324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5371OtherADULT RESIDENTIAL