Provider Demographics
NPI:1871615583
Name:MEND INC.
Entity type:Organization
Organization Name:MEND INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-257-4672
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-0362
Mailing Address - Country:US
Mailing Address - Phone:505-257-4672
Mailing Address - Fax:505-257-4762
Practice Address - Street 1:229 RIO ST
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7401
Practice Address - Country:US
Practice Address - Phone:505-257-4672
Practice Address - Fax:505-257-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD0161Medicaid