Provider Demographics
NPI:1831243732
Name:NA'NIZHOOZHI CENTER, INC.
Entity type:Organization
Organization Name:NA'NIZHOOZHI CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAW
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-722-2177
Mailing Address - Street 1:2205 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7404
Mailing Address - Country:US
Mailing Address - Phone:505-722-2177
Mailing Address - Fax:505-722-5961
Practice Address - Street 1:2205 BOYD AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-7404
Practice Address - Country:US
Practice Address - Phone:505-722-2177
Practice Address - Fax:505-722-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5550324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility