Provider Demographics
NPI:1346748282
Name:MESCALERO APACHE TRIBE
Entity Type:Organization
Organization Name:MESCALERO APACHE TRIBE
Other - Org Name:MESCALERO SYSTEM OF CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOELLYN
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:MAGOOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-464-9274
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0227
Mailing Address - Country:US
Mailing Address - Phone:575-464-4301
Mailing Address - Fax:575-464-3404
Practice Address - Street 1:311 WAR BONNET DRIVE
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340
Practice Address - Country:US
Practice Address - Phone:575-464-4301
Practice Address - Fax:575-464-3404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MESCALERO APACHE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health