Basic Information
| Provider Information | |||||||||
| NPI: | 1649697657 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NM FAMILY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3465 MCNUTT RD | ||||||||
| Address2: | |||||||||
| City: | SUNLAND PARK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880639056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759151338 | ||||||||
| FaxNumber: | 5759151819 | ||||||||
| Practice Location | |||||||||
| Address1: | 3465 MCNUTT RD | ||||||||
| Address2: | |||||||||
| City: | SUNLAND PARK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880639056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759151338 | ||||||||
| FaxNumber: | 5759151819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5759151338 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DIRECTOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | CS00219819 | NM | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 172V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Community Health Worker | 174200000X | N | Other Service Providers | Meals | 174H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Health Educator | 175T00000X | N | 193200000X MULTI-SPECIALTY GROUP | 363LF0000X | 607417 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 251B00000X | N | Agencies | Case Management | 251S00000X | N | Agencies | Community/Behavioral Health | 261QA0600X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 332U00000X | N | Suppliers | Home Delivered Meals | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 24256536 | 05 | NM | MEDICAID |