Provider Demographics
NPI:1457586877
Name:KIDS' SAFEHOUSE OF EDDY COUNTY
Entity Type:Organization
Organization Name:KIDS' SAFEHOUSE OF EDDY COUNTY
Other - Org Name:EDDY COUNTY SAFEHOUSE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADALINE
Authorized Official - Middle Name:LINDE
Authorized Official - Last Name:MERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:575-885-9763
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:575-885-9763
Mailing Address - Fax:575-628-8394
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:575-885-9763
Practice Address - Fax:575-628-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health