OrganizationActive
Jicarilla Apache Nation
NPI 1881020089 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Dulce, NM
Provider details
- NPI number
- 1881020089
- Entity type
- Organization
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Ty Vicenti, President(575) 759-4201
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
450 N Mundo Dr.
Dulce, NM 87528
Phone: (575) 759-4206
Fax: (575) 759-4471
Approximate (ZIP-level) locationGet directions
Mailing address
450 N Mundo Dr.
Dulce, NM 87528
Other names (DBA / former)
- Doing business as
- Jicarilla Apache Nation Dialysis Treatment Center
Registry dates
- Enumerated
- 2013-09-19
- Last updated
- 2015-05-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.