Provider Demographics
NPI:1578881868
Name:ALIANZA OF NEW MEXICO
Entity Type:Organization
Organization Name:ALIANZA OF NEW MEXICO
Other - Org Name:PECOS VALLEY HIV/AIDS RESOURCE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:575-623-1995
Mailing Address - Street 1:1200 S RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-5577
Mailing Address - Country:US
Mailing Address - Phone:575-623-1995
Mailing Address - Fax:575-623-1998
Practice Address - Street 1:1200 S RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5577
Practice Address - Country:US
Practice Address - Phone:575-623-1995
Practice Address - Fax:575-623-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D3323Medicaid