NPIMap

Organization Active NPI

New Mexico Department of Health

Doing business as Los Lunas Community Program

  • Intellectual Disabilities Intermediate Care Facility
  • Belen, NM
National Provider Identifier
1124189048
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
5240 Issued in NM
Legal business name
NEW MEXICO DEPARTMENT OF HEALTH
Doing business as
Los Lunas Community Program
Practice address
84 Estancia Road
Belen, NM 87002
Phone
(505) 864-4015
Fax
(505) 841-5316
NPI assigned
Dec 13, 2006
Last updated
Feb 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Caitlyn Blaine
Title
Finance Director
Phone
(505) 264-5456

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 5240 NM Primary

Addresses

Primary practice location

84 Estancia Road
Belen, NM 87002

Mailing address

445 Camino del Rey SW
Suite a
Los Lunas, NM 87031
Phone (505) 222-0900

Other identifiers 1

IdentifierTypeStateIssuer
M2402MedicaidNM

Other names 1

  • Los Lunas Community Program Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124189048. Details of each certification follow.

  • CCN 32G053 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 32G053

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Los Lunas Community Program/Behavioral Services Center
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 3, 2001
Last certification
Feb 10, 2025
Beds
4
Ownership / control type
State
Facility address
84 Estancia Road
Belen, NM 87002

National Provider Directory

National Provider Directory
Tax ID family
Children's Medical Services43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

445 Camino del Rey Dr
Ste A
Los Lunas, NM 87031
Phone (505) 400-5420

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1124189048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 CAMINO DEL REY SW",
            "address_2": "SUITE A",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "87031",
            "telephone_number": "505-222-0900",
            "fax_number": "505-222-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 ESTANCIA ROAD",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "87002",
            "telephone_number": "505-864-4015",
            "fax_number": "505-841-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MEXICO DEPARTMENT OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "BLAINE",
        "authorized_official_first_name": "CAITLYN",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "505-264-5456"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NM",
            "license": "5240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M2402",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Los Lunas Community Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belen, NM

Sources for this page

Verify at the official NPI Registry.