Healthcare Provider Details

I. General information

NPI: 1255963898
Provider Name (Legal Business Name): NEW HAVEN BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOUISIANA BLVD NE STE C1
ALBUQUERQUE NM
87110-3576
US

IV. Provider business mailing address

122 SWEET GUM ST
RED OAK TX
75154-0139
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-7873
  • Fax: 844-272-9056
Mailing address:
  • Phone: 817-966-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE HARDWRICK
Title or Position: PSYCHIATRIC MENTAL HEALTH NURSE PRA
Credential: NP
Phone: 817-966-6681