Provider Demographics
NPI:1750470415
Name:LEADERS INDUSTRIES
Entity Type:Organization
Organization Name:LEADERS INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-393-8201
Mailing Address - Street 1:115 W DUNNAM ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6020
Mailing Address - Country:US
Mailing Address - Phone:505-393-8201
Mailing Address - Fax:505-393-1318
Practice Address - Street 1:115 W DUNNAM ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6020
Practice Address - Country:US
Practice Address - Phone:505-393-8201
Practice Address - Fax:505-393-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02143726002251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD0612Medicaid
NME7425Medicaid