Provider Demographics
NPI:1841764776
Name:MORA VALLEY COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:MORA VALLEY COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:575-387-5069
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:575-387-9011
Practice Address - Street 1:3 MORA VALLEY CLINIC RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-0209
Practice Address - Country:US
Practice Address - Phone:575-387-5069
Practice Address - Fax:575-387-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)