Provider Demographics
NPI:1801093562
Name:COMMUNITY AGAINST VIOLENCE
Entity type:Organization
Organization Name:COMMUNITY AGAINST VIOLENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-758-8082
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0169
Mailing Address - Country:US
Mailing Address - Phone:505-758-8082
Mailing Address - Fax:505-758-4051
Practice Address - Street 1:945 SALAZAR ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-8082
Practice Address - Fax:505-758-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health