Provider Demographics
NPI:1548323926
Name:RIO ARRIBA HEALTH AND HUMAN SERVICES
Entity type:Organization
Organization Name:RIO ARRIBA HEALTH AND HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-HEALTH & HUMAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:I
Authorized Official - Last Name:REICHELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-753-3143
Mailing Address - Street 1:P.O. BOX 94508
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-5408
Mailing Address - Country:US
Mailing Address - Phone:505-384-7352
Mailing Address - Fax:505-274-7338
Practice Address - Street 1:1100 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3454
Practice Address - Country:US
Practice Address - Phone:505-753-3143
Practice Address - Fax:505-753-1769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIO ARRIBA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM04710251B00000X
251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41055853Medicaid
NMNM600621OtherPROVIDER ID