Provider Demographics
NPI:1942402235
Name:KIDS' SAFEHOUSE OF EDDY COUNTY
Entity Type:Organization
Organization Name:KIDS' SAFEHOUSE OF EDDY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-885-9763
Mailing Address - Street 1:PO BOX 2314
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-2314
Mailing Address - Country:US
Mailing Address - Phone:505-885-9763
Mailing Address - Fax:505-628-8394
Practice Address - Street 1:502 S HALAGUENO ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5635
Practice Address - Country:US
Practice Address - Phone:505-885-9763
Practice Address - Fax:505-628-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMVNM00537OtherVALUE OPTIONS PROVIDER NU