Provider Demographics
NPI:1881767366
Name:CYFD-STATE OF NEW MEXICO-CARLSBAD CRF
Entity type:Organization
Organization Name:CYFD-STATE OF NEW MEXICO-CARLSBAD CRF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUREAU CHIEF, CYFDJJS ENTITLEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-841-6372
Mailing Address - Street 1:300 SAN MATEO BLVD NE STE 410
Mailing Address - Street 2:300 SAN MATEO BLVD, NE, SUITE 410
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1503
Mailing Address - Country:US
Mailing Address - Phone:505-841-6372
Mailing Address - Fax:505-841-2949
Practice Address - Street 1:106 N MESQUITE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4960
Practice Address - Country:US
Practice Address - Phone:505-885-8781
Practice Address - Fax:505-885-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7275322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600533VNM00239NOOtherVALUE OPTIONS
NMH1847Medicaid