Provider Demographics
NPI:1912124835
Name:NEW MEXICO AGING & LONG TERM
Entity Type:Organization
Organization Name:NEW MEXICO AGING & LONG TERM
Other - Org Name:AGING & LONG-TERM SERVICES DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-476-4781
Mailing Address - Street 1:2550 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3260
Mailing Address - Country:US
Mailing Address - Phone:505-476-4799
Mailing Address - Fax:505-476-4836
Practice Address - Street 1:2550 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3260
Practice Address - Country:US
Practice Address - Phone:505-476-4799
Practice Address - Fax:505-476-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management