Provider Demographics
NPI:1558435719
Name:SOLACE CRISIS TREATMENT CENTER
Entity Type:Organization
Organization Name:SOLACE CRISIS TREATMENT CENTER
Other - Org Name:SANTA FE RAPE CRISIS AND TRAUMA TREATMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DUNHAM
Authorized Official - Last Name:RANSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-988-1951
Mailing Address - Street 1:6601 VALENTINE WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7301
Mailing Address - Country:US
Mailing Address - Phone:505-988-1951
Mailing Address - Fax:505-988-1906
Practice Address - Street 1:6601 VALENTINE WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7301
Practice Address - Country:US
Practice Address - Phone:505-988-1951
Practice Address - Fax:505-988-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ-2609Medicaid