Healthcare Provider Details

I. General information

NPI: 1124763529
Provider Name (Legal Business Name): VANGUARD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 KENTUCKY CT NE
ALBUQUERQUE NM
87110-3411
US

IV. Provider business mailing address

6809 KENTUCKY CT NE
ALBUQUERQUE NM
87110-3411
US

V. Phone/Fax

Practice location:
  • Phone: 480-320-0752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE BRIGGS
Title or Position: CEO/OWNER
Credential:
Phone: 480-320-0752