Provider Demographics
NPI:1669535837
Name:CHIMAYO YOUTH CONSERVATION CORPS
Entity type:Organization
Organization Name:CHIMAYO YOUTH CONSERVATION CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-351-1456
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-1027
Mailing Address - Country:US
Mailing Address - Phone:505-351-1456
Mailing Address - Fax:505-351-1556
Practice Address - Street 1:CR103, MANZANA CENTER-BUILDING 3
Practice Address - Street 2:
Practice Address - City:CHIMAYO
Practice Address - State:NM
Practice Address - Zip Code:87522-1027
Practice Address - Country:US
Practice Address - Phone:505-351-1456
Practice Address - Fax:505-351-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable