| Citizens For The Developmentally Disabled, Inc. | |
|
230 4th Ave Raton NM 87740-2643 | |
| (505) 445-5674 | |
| (505) 445-8254 |
| Full Name | Citizens For The Developmentally Disabled, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 230 4th Ave, Raton, New Mexico |
| Authorized Official Name and Position | Bobby Ledoux (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5054455674 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Citizens For The Developmentally Disabled, Inc. Po Box 1589 230 4th Ave. Raton NM 87740-1589 Ph: (505) 445-5674 | Citizens For The Developmentally Disabled, Inc. 230 4th Ave Raton NM 87740-2643 Ph: (505) 445-5674 |
| NPI Number | 1649311721 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 02/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649311721 | NPI | - | NPPES |
| E7272 | Medicaid | NM | |
| D0208 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 01135142000 (New Mexico) | Primary |
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