JICARILLA APACHE NATION (NPI# 1508051061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508051061 |
| Entity Type | Organization |
| Organization Name | JICARILLA APACHE NATION |
| Other Organization Name | JICARILLA BEHAVIORAL HEALTH |
| Practice Address |
109 Seneca Drive Dulce NM 87528 |
| Mailing Address |
Po Box 546 Dulce NM 87528-0546 |
| Practice Telephone | 5057593162 |
| Practice Fax Number | 5057593588 |
| Mailing Telephone | 5057593162 |
| Mailing Fax Number | 5057593588 |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2007-09-07 |
| Authorized Official Name | MR. LEVI PESATA (PRESIDENT) |
| Authorized Official Telephone | 5057593242 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Jicarilla Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881020089 | Jicarilla Apache Nation | Clinic/Center | 450 N Mundo Dr., Dulce, NM 87528 | 2013-09-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | JICARILLA APACHE NATION | 25 Hawks Dr, Dulce, NM 87528 |
| System for Award Management (SAM) Entities | JICARILLA APACHE NATION POWER AUTHORITY | 50 North Mundo Dr, Dulce, NM 87528 |
| Street Address |
109 SENECA DRIVE |
| City | DULCE |
| State | NM |
| Zip Code | 87528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376737825 | Marlene Joy Velarde | Social Worker | 109 Seneca Drive, Dulce, NM 87528 | 2007-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164917373 | Kelly Rae Pettigrew | Optometrist | 505 North Mundo, Dulce, NM 87528 | 2018-06-29 |
| 1780003442 | Jacob Alexander | Preventive Medicine | 500 N. Mundo, Dulce, NM 87528 | 2014-04-09 |
| 1881020089 | Jicarilla Apache Nation | Clinic/Center | 450 N Mundo Dr., Dulce, NM 87528 | 2013-09-19 |
| 1285971515 | Samuel Taylor Cropp | Pharmacist | 500 N Mundo Dr, Dulce, NM 87528 | 2013-01-07 |
| 1720331697 | Northwest Reional Education Coop #2 | Student in an Organized Health Care Education/Training Program | 91 Hawk Drive, Dulce, NM 87528 | 2012-10-17 |
| 1306116066 | Michael Shawn Kennedy | Psychologist | 113 Hawk Dr, Dulce, NM 87528 | 2012-01-11 |
| 1669762043 | Veronica A Medlin | Technician, Pathology | 1200 Stone Lake Rd, Dulce, NM 87528 | 2011-04-19 |
| 1891085262 | Stella Elizabeth Wilson | Spec/Tech, Pathology | 500 Stone Lake Road, Dulce, NM 87528 | 2011-04-19 |
| 1134419518 | Ray Morris Joe | Technician, Pathology | 500 North Mundo Road, Dulce, NM 87528 | 2011-04-19 |
| 1801186341 | Raquel Irene Cisneros | Family Medicine | 500 N. Mundo Dr., Dulce, NM 87528 | 2011-04-18 |
| Find all providers in zip 87528 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396345328 | The People's Counseling and Consulting, LLC | Community/Behavioral Health | 4718 Idlewilde Ln Se, Albuquerque, NM 87108-3424 | 2020-10-28 |
| 1861090342 | Rio Grande Emdr Therapy, LLC | Community/Behavioral Health | 6 Sierra Vista Drive, Cedar Crest, NM 87008 | 2020-10-15 |
| 1306443924 | Recovery Innovations, Inc | Community/Behavioral Health | 1850 Copper Loop Bldg B, Las Cruces, NM 88005-8139 | 2020-10-06 |
| 1689271413 | Thriving Mind LLC | Community/Behavioral Health | 4612 Huyana Dr Nw, Albuquerque, NM 87120-5597 | 2020-10-05 |
| 1922612951 | Connections Counseling LLC | Community/Behavioral Health | 11920 Dahlia Ave Se, Albuquerque, NM 87123-2470 | 2020-09-08 |
| 1538771357 | Ariane Mahmud-ghazi, LLC | Community/Behavioral Health | 1604 Young St, Santa Fe, NM 87505-3504 | 2020-08-21 |
| 1790301026 | Capitan Therapy & Behavioral Health | Community/Behavioral Health | 102 East Smokey Bear Blvd, Capitan, NM 88316 | 2020-06-23 |
| 1396360871 | Integrity Behavior Improvement Services, LLC | Community/Behavioral Health | 1916 Amherst Dr Ne, Albuquerque, NM 87106-1105 | 2020-06-10 |
| 1871116236 | Carsal LLC | Community/Behavioral Health | 6501 4th St Nw Ste E2, Los Ranchos, NM 87107-5800 | 2020-05-20 |
| 1023647096 | Inner Peace Outreach LLC | Community/Behavioral Health | 3107 San Mateo Blvd Ne, Albuquerque, NM 87110-1921 | 2020-04-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.