Provider Demographics
NPI:1568678720
Name:NEW MEXICO NEW START
Entity Type:Organization
Organization Name:NEW MEXICO NEW START
Other - Org Name:NEW MEXICO NEW START
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-762-6091
Mailing Address - Street 1:P.O. BOX 4907
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502
Mailing Address - Country:US
Mailing Address - Phone:505-762-6091
Mailing Address - Fax:505-762-2815
Practice Address - Street 1:603 AVENIDA CELAYA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-3435
Practice Address - Country:US
Practice Address - Phone:505-762-6091
Practice Address - Fax:505-762-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600357OtherVALUE OPTIONS OF NEW MEXI