Provider Demographics
NPI:1043368244
Name:NORTHERN NM VOCATIONAL TRAINING
Entity type:Organization
Organization Name:NORTHERN NM VOCATIONAL TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:REINBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-852-4585
Mailing Address - Street 1:1860 HIGHWAY 68
Mailing Address - Street 2:BOX 273
Mailing Address - City:EMBUDO
Mailing Address - State:NM
Mailing Address - Zip Code:87531-0273
Mailing Address - Country:US
Mailing Address - Phone:505-852-4585
Mailing Address - Fax:505-852-4585
Practice Address - Street 1:1860 HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:EMBUDO
Practice Address - State:NM
Practice Address - Zip Code:87531-0273
Practice Address - Country:US
Practice Address - Phone:505-852-4585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D4191Medicaid