Provider Demographics
NPI:1376770214
Name:THE CONSORTIUM
Entity Type:Organization
Organization Name:THE CONSORTIUM
Other - Org Name:REGIONAL SUBSTANCE ABUSE TREATMENT INITIATIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-355-8038
Mailing Address - Street 1:571 NORTH TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119-0427
Mailing Address - Country:US
Mailing Address - Phone:575-355-8038
Mailing Address - Fax:
Practice Address - Street 1:571 NORTH TENTH STREET
Practice Address - Street 2:
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119-0427
Practice Address - Country:US
Practice Address - Phone:575-355-8038
Practice Address - Fax:575-355-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility