Provider Demographics
NPI:1710630231
Name:RIO ARRIBA COUNTY
Entity Type:Organization
Organization Name:RIO ARRIBA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LADAC
Authorized Official - Phone:505-747-1418
Mailing Address - Street 1:1122 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3453
Mailing Address - Country:US
Mailing Address - Phone:505-747-1418
Mailing Address - Fax:
Practice Address - Street 1:1101 INDUSTRIAL PARK RD STE B
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2629
Practice Address - Country:US
Practice Address - Phone:505-747-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIO ARRIBA COUNTY HHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health