Provider Demographics
NPI:1013293885
Name:MIDWAY YOUTH AND FAMILY DEVELOPMENT CENTER, INC
Entity Type:Organization
Organization Name:MIDWAY YOUTH AND FAMILY DEVELOPMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-347-5309
Mailing Address - Street 1:75 YAKIMA RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NM
Mailing Address - Zip Code:88230-9757
Mailing Address - Country:US
Mailing Address - Phone:575-347-5309
Mailing Address - Fax:575-347-5753
Practice Address - Street 1:75 YAKIMA RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NM
Practice Address - Zip Code:88230-9757
Practice Address - Country:US
Practice Address - Phone:575-347-5309
Practice Address - Fax:575-347-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty