| Organization Name: | TIGER DEN WELLNESS CENTER |
| NPI Number: | 1962730010 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES ADRIAN ABREU (EXECUTIVE DIRECTOR) |
| Mailing Address: | 1535 Tiger Circle Raton |
| State: | NM US |
| Postal Code: | 87740 |
| Phone Number: | 5754453641 |
| Fax Number: | 5754458641 |
| NPI Enumeration Date: | 12/01/2009 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251300000X |
| License Number: | CL00010535 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Local Education Agency (LEA) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 |