NPIMap

Organization Active NPI

Santa Maria El Mirador

  • Developmentally Disabled Services Day Training Agency
  • Santa Fe, NM
National Provider Identifier
1619150463
Registry record updated Dec 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
02347611007 Issued in NM
Legal business name
SANTA MARIA EL MIRADOR
Practice address
2041 S Pacheco St
Suite 100
Santa Fe, NM 87505-5473
Phone
(505) 424-7700
Fax
(505) 424-7707
NPI assigned
Dec 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2007

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

Authorized official

Name
Mr. Eloy F Duran
Title
Deputy Director of Finance
Phone
(505) 428-2004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 02347611007 NM Primary

Addresses

Primary practice location

2041 S Pacheco St
Suite 100
Santa Fe, NM 87505-5473

Mailing address

2041 S Pacheco St
Suite 100
Santa Fe, NM 87505-5473
Phone (505) 424-7700

Other identifiers 1

IdentifierTypeStateIssuer
60205512MedicaidNM

Other names 1

  • Fraternal Order of Knights Templar (FOKT) Other name

National Provider Directory

National Provider Directory
Tax ID family
Fraternal Order of Knights Templar Fokt3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2041 S Pacheco St
Ste 100
Santa Fe, NM 87505
Phone (505) 424-7700

NPI Registry JSON

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197590400000",
    "number": "1619150463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 S PACHECO ST",
            "address_2": "SUITE 100",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875055473",
            "telephone_number": "505-424-7700",
            "fax_number": "505-424-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 S PACHECO ST",
            "address_2": "SUITE 100",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875055473",
            "telephone_number": "505-424-7700",
            "fax_number": "505-424-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MARIA EL MIRADOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2007-12-14",
        "status": "A",
        "authorized_official_last_name": "DURAN",
        "authorized_official_first_name": "ELOY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "505-428-2004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NM",
            "license": "02347611007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60205512",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fraternal Order of Knights Templar (FOKT)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.