Healthcare Provider Details

I. General information

NPI: 1437967734
Provider Name (Legal Business Name): NM CHILDREN, YOUTH & FAMILIES DEPARTMENT - JUVENILE JUSTICE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 EDITH BLVD NE
ALBUQUERQUE NM
87107-2222
US

IV. Provider business mailing address

4000 EDITH BLVD NE
ALBUQUERQUE NM
87107-2222
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-2400
  • Fax:
Mailing address:
  • Phone: 505-331-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG NELSON
Title or Position: BUREAU CHIEF PERFORMANCE & QUALITY
Credential:
Phone: 505-331-8562