Provider Demographics
NPI:1346604329
Name:NORTHERN NEW MEXICO HEARING AND BALANCE INSTITUTE, LLC
Entity Type:Organization
Organization Name:NORTHERN NEW MEXICO HEARING AND BALANCE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:O'DAY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:505-780-8301
Mailing Address - Street 1:1911 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5403
Mailing Address - Country:US
Mailing Address - Phone:505-780-8301
Mailing Address - Fax:505-780-5418
Practice Address - Street 1:1911 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5403
Practice Address - Country:US
Practice Address - Phone:505-780-8301
Practice Address - Fax:505-780-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5494320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities