Provider Demographics
NPI:1265765135
Name:ANA RIO RANCHO LTD CO
Entity type:Organization
Organization Name:ANA RIO RANCHO LTD CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:505-994-4100
Mailing Address - Street 1:1603 GOLF COURSE RD SE # A
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1762
Mailing Address - Country:US
Mailing Address - Phone:505-994-4100
Mailing Address - Fax:505-994-1229
Practice Address - Street 1:1603 GOLF COURSE RD SE # A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1762
Practice Address - Country:US
Practice Address - Phone:505-994-4100
Practice Address - Fax:505-994-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3468251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3468OtherNM LICENSE