Provider Demographics
NPI:1790072163
Name:PASOS ADELANTE
Entity Type:Organization
Organization Name:PASOS ADELANTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-589-2400
Mailing Address - Street 1:101 MAGUEY CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9513
Mailing Address - Country:US
Mailing Address - Phone:575-589-2400
Mailing Address - Fax:
Practice Address - Street 1:101 MAGUEY CT
Practice Address - Street 2:SUITE 1
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9513
Practice Address - Country:US
Practice Address - Phone:575-589-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0118221302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1548439136Medicaid