Provider Demographics
NPI:1689790347
Name:NORTH FOURTH ART CENTER
Entity Type:Organization
Organization Name:NORTH FOURTH ART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NESET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-345-2872
Mailing Address - Street 1:4904 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3906
Mailing Address - Country:US
Mailing Address - Phone:505-345-2872
Mailing Address - Fax:505-345-2896
Practice Address - Street 1:4904 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3906
Practice Address - Country:US
Practice Address - Phone:505-345-2872
Practice Address - Fax:505-345-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1126820251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D1281Medicaid