Provider Demographics
NPI:1740447069
Name:SAN JUAN COUNTY
Entity type:Organization
Organization Name:SAN JUAN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-325-1720
Mailing Address - Street 1:1006 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5442
Mailing Address - Country:US
Mailing Address - Phone:505-325-1720
Mailing Address - Fax:505-325-1611
Practice Address - Street 1:1006 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5442
Practice Address - Country:US
Practice Address - Phone:505-325-1720
Practice Address - Fax:505-325-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility