Provider Demographics
NPI:1992388425
Name:AMIKIDS NEW MEXICO, INC
Entity Type:Organization
Organization Name:AMIKIDS NEW MEXICO, INC
Other - Org Name:AMIKIDS BERNALILLO FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-987-7816
Mailing Address - Street 1:5915 BENJAMIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5239
Mailing Address - Country:US
Mailing Address - Phone:813-734-5678
Mailing Address - Fax:
Practice Address - Street 1:6208 MONTGOMERY BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1400
Practice Address - Country:US
Practice Address - Phone:910-987-7816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare