Healthcare Provider Details

I. General information

NPI: 1679839963
Provider Name (Legal Business Name): HIGH DESERT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 PROSPECT PL NE STE 100
ALBUQUERQUE NM
87110-4315
US

IV. Provider business mailing address

7001 PROSPECT PL NE STE 100
ALBUQUERQUE NM
87110-4315
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4530
  • Fax: 505-823-4538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberT-0147511
License Number StateNM

VIII. Authorized Official

Name: MR. DENNIS JAMES
Title or Position: CEO
Credential: LISW
Phone: 505-823-4530