Provider Demographics
NPI:1942424759
Name:CARC, INC.
Entity Type:Organization
Organization Name:CARC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-887-1570
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-1808
Mailing Address - Country:US
Mailing Address - Phone:505-887-1570
Mailing Address - Fax:505-885-5135
Practice Address - Street 1:902 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-8804
Practice Address - Country:US
Practice Address - Phone:505-887-1570
Practice Address - Fax:505-885-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E7383Medicaid