Provider Demographics
NPI:1790179844
Name:EIGHT NORTHERN INDIAN PUEBLOS
Entity Type:Organization
Organization Name:EIGHT NORTHERN INDIAN PUEBLOS
Other - Org Name:BUTTERFLY HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-692-5034
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-751-7688
Mailing Address - Fax:575-757-7208
Practice Address - Street 1:1130 BUTTERFLY ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-751-7688
Practice Address - Fax:575-751-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-089063245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children