Provider Demographics
NPI:1497269187
Name:ME TOWN ENTERPRISES LLC
Entity Type:Organization
Organization Name:ME TOWN ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-363-3293
Mailing Address - Street 1:PO BOX 28628
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8628
Mailing Address - Country:US
Mailing Address - Phone:505-310-9069
Mailing Address - Fax:505-780-5529
Practice Address - Street 1:2916 GOVERNOR MABRY CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6438
Practice Address - Country:US
Practice Address - Phone:505-310-9069
Practice Address - Fax:505-780-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage