Provider Demographics
NPI:1922333285
Name:YOUTH SHELTERS
Entity Type:Organization
Organization Name:YOUTH SHELTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SINTE
Authorized Official - Last Name:TORREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-0586
Mailing Address - Street 1:PO BOX 28279
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8279
Mailing Address - Country:US
Mailing Address - Phone:505-983-0586
Mailing Address - Fax:505-424-0949
Practice Address - Street 1:5686 AGUA FRIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9001
Practice Address - Country:US
Practice Address - Phone:505-983-0586
Practice Address - Fax:505-424-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health