Provider Demographics
NPI:1508143868
Name:LUNA COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:LUNA COMMUNITY COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AREA HEALTH EDUCATION CTR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:VALERIE
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-454-2585
Mailing Address - Street 1:366 LUNA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9838
Mailing Address - Country:US
Mailing Address - Phone:505-454-2585
Mailing Address - Fax:505-454-5326
Practice Address - Street 1:366 LUNA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9838
Practice Address - Country:US
Practice Address - Phone:505-454-2585
Practice Address - Fax:505-454-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-0458252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency