Healthcare Provider Details

I. General information

NPI: 1891318747
Provider Name (Legal Business Name): B2 HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8204 LOUISIANA BLVD NE STE A
ALBUQUERQUE NM
87113-1737
US

IV. Provider business mailing address

PO BOX 16196
ALBUQUERQUE NM
87191-6196
US

V. Phone/Fax

Practice location:
  • Phone: 505-582-2180
  • Fax: 505-639-4145
Mailing address:
  • Phone: 505-480-5156
  • Fax: 505-639-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AVA A BOSWELL
Title or Position: OWNER
Credential: MD
Phone: 505-480-5156