Provider Demographics
NPI:1558942391
Name:HOY RECOVERY WOMENS PROGRAM
Entity Type:Organization
Organization Name:HOY RECOVERY WOMENS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAROS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC
Authorized Official - Phone:505-852-2580
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-852-2580
Mailing Address - Fax:505-852-1827
Practice Address - Street 1:365 COUNTY RD 40
Practice Address - Street 2:
Practice Address - City:ALCALDE
Practice Address - State:NM
Practice Address - Zip Code:87511-0121
Practice Address - Country:US
Practice Address - Phone:505-852-1828
Practice Address - Fax:505-852-1827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOY RECOVERY PROGRAM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23501090Medicaid