Provider Demographics
NPI:1710343942
Name:PUEBLO OF ACOMA
Entity Type:Organization
Organization Name:PUEBLO OF ACOMA
Other - Org Name:ACOMA BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CLINICIAN, BHS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC
Authorized Official - Phone:505-552-6661
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0328
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:505-552-6426
Practice Address - Street 1:45 PINSBAARI DRIVE
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034-0328
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:505-552-6426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle