Provider Demographics
NPI:1578794871
Name:NORTH CENTRAL COMMUNITY BASED SERVICES, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL COMMUNITY BASED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:575-756-2327
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:16542 HWY 84
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0617
Mailing Address - Country:US
Mailing Address - Phone:575-756-2327
Mailing Address - Fax:575-756-1897
Practice Address - Street 1:16542 HWY 84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0617
Practice Address - Country:US
Practice Address - Phone:575-756-2327
Practice Address - Fax:575-756-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health