| Khadjenoury Llc | |
|
8 Hawk Circle Edventures C/o Thoreau Middle School Thoreau NM 87323 | |
| (801) 833-0568 | |
| (801) 930-9134 |
| Full Name | Khadjenoury Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 8 Hawk Circle, Thoreau, New Mexico |
| Authorized Official Name and Position | Siamak Khadjenoury (CEO) |
| Authorized Official Contact | 8018330568 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Khadjenoury Llc 8 Hawk Circle Thoreau Middle School Thoreau NM 84732 Ph: (801) 833-0568 | Khadjenoury Llc 8 Hawk Circle Edventures C/o Thoreau Middle School Thoreau NM 87323 Ph: (801) 833-0568 |
| NPI Number | 1861773004 |
|---|---|
| Provider Enumeration Date | 09/01/2011 |
| Last Update Date | 09/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861773004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |