Provider Demographics
NPI:1760421168
Name:GUIDANCE FOUNDATION INC
Entity Type:Organization
Organization Name:GUIDANCE FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-892-3639
Mailing Address - Street 1:4101 BARBARA LOOP SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1009
Mailing Address - Country:US
Mailing Address - Phone:505-892-3639
Mailing Address - Fax:505-892-6348
Practice Address - Street 1:4101 BARBARA LOOP SE
Practice Address - Street 2:SUITE D
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1009
Practice Address - Country:US
Practice Address - Phone:505-892-3639
Practice Address - Fax:505-892-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR14768261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98648Medicaid
NM98648Medicaid
NM331332404Medicare ID - Type Unspecified