Provider Demographics
NPI:1861839235
Name:ANGELA CHAVEZ
Entity Type:Organization
Organization Name:ANGELA CHAVEZ
Other - Org Name:PREMIER DEVELOPMENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-420-9541
Mailing Address - Street 1:607 S LEA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-4567
Mailing Address - Country:US
Mailing Address - Phone:575-420-9541
Mailing Address - Fax:
Practice Address - Street 1:607 S LEA AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4567
Practice Address - Country:US
Practice Address - Phone:575-420-9541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities