MEDICARE: COREWELL BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1841161064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COREWELL BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3321 CANDELARIA RD NE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1969
Country	:	US
Telephone Number	:	505-225-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 CANDELARIA RD NE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1969
Country	:	US
Telephone Number	:	505-225-2776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE KELLEY
Credential	:
Telephone Number	:	480-331-5184

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	03/02/2026

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