Provider Demographics
NPI:1376662874
Name:SOUTHERN NEW MEXICO HUMAN DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:SOUTHERN NEW MEXICO HUMAN DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-882-5101
Mailing Address - Street 1:PO BOX 2285
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2285
Mailing Address - Country:US
Mailing Address - Phone:505-882-5101
Mailing Address - Fax:505-882-6127
Practice Address - Street 1:820 HWY 478
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:505-882-5101
Practice Address - Fax:505-882-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3037251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47639Medicaid