Provider Demographics
NPI:1639316540
Name:VALENCIA SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE
Entity Type:Organization
Organization Name:VALENCIA SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-864-3202
Mailing Address - Street 1:513 BECKER AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3631
Mailing Address - Country:US
Mailing Address - Phone:505-864-3202
Mailing Address - Fax:505-864-8138
Practice Address - Street 1:513 BECKER AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3631
Practice Address - Country:US
Practice Address - Phone:505-864-3202
Practice Address - Fax:505-864-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health