Provider Demographics
NPI:1619040722
Name:CHILDREN, YOUTH & FAMILIES DEPT.-PROTECTIVE SERVICES
Entity Type:Organization
Organization Name:CHILDREN, YOUTH & FAMILIES DEPT.-PROTECTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR-PROTECTIVE SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-827-8400
Mailing Address - Street 1:P. O. DRAWER 5160
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-5160
Mailing Address - Country:US
Mailing Address - Phone:505-827-8400
Mailing Address - Fax:505-827-8433
Practice Address - Street 1:1120 PASEO DE PERALTA
Practice Address - Street 2:PERA BUILDING
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2747
Practice Address - Country:US
Practice Address - Phone:505-827-8400
Practice Address - Fax:505-827-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E7536Medicaid