Provider Demographics
NPI:1710053293
Name:CYFD-STATE OF NEW MEXICO-TCM
Entity Type:Organization
Organization Name:CYFD-STATE OF NEW MEXICO-TCM
Other - Org Name:TARGETED CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUREAU CHIEF, CYFDJJS ENTITLEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-841-6372
Mailing Address - Street 1:300 SAN MATEO BLVD NE STE 410
Mailing Address - Street 2:300 SAN MATEO BLVD NE STE 410
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1503
Mailing Address - Country:US
Mailing Address - Phone:505-841-6372
Mailing Address - Fax:505-841-2949
Practice Address - Street 1:300 SAN MATEO BLVD NE STE 410
Practice Address - Street 2:300 SAN MATEO BLVD NE STE 410
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1503
Practice Address - Country:US
Practice Address - Phone:505-841-6372
Practice Address - Fax:505-841-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74475Medicaid