| Organization Name: | BOBBY COYNE LLC |
| NPI Number: | 1124267968 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT JOSEPH COYNE (CLINICAL DIRECTOR) |
| Mailing Address: | 127 Eastgate Dr Ste 212 H Los Alamos |
| State: | NM US |
| Postal Code: | 875443300 |
| Phone Number: | 5056619700 |
| Fax Number: | 5056630100 |
| NPI Enumeration Date: | 02/18/2009 |
| NPI Last Update Date: | 02/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 4758 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |