Provider Demographics
NPI:1295971505
Name:TAOS PUEBLO DIVISION OF HEALTH AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:TAOS PUEBLO DIVISION OF HEALTH AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBAL PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-8626
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-758-7824
Mailing Address - Fax:575-758-3346
Practice Address - Street 1:1090 GOAT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-7824
Practice Address - Fax:575-758-3346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAOS PUEBLO CENTRAL MANAGEMENT SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health