| Organization Name: | JICARILLA APACHE HEALTH CARE FACILITY |
| NPI Number: | 1346326600 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARRI REA HERBEL (URGENT CARE NURSE) |
| Mailing Address: | 12000 Stone Lake Rd Dulce |
| State: | NM US |
| Postal Code: | 875280187 |
| Phone Number: | 5057597258 |
| Fax Number: | 5057597258 |
| NPI Enumeration Date: | 10/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | L10182 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |