Provider Demographics
NPI:1134260904
Name:UNM DEVELOPMENTAL CARE PROGRAM
Entity type:Organization
Organization Name:UNM DEVELOPMENTAL CARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FURGANG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTRL
Authorized Official - Phone:505-925-4080
Mailing Address - Street 1:MSC10 5590
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-3946
Mailing Address - Fax:505-925-4089
Practice Address - Street 1:MSC10 5590
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3946
Practice Address - Fax:505-925-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6005261QD1600X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Not Answered282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ4226Medicaid