Healthcare Provider Details

I. General information

NPI: 1093079303
Provider Name (Legal Business Name): HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE 4TH FLOOR
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

3102 W END AVE SUITE 1000
NASHVILLE TN
37203-1301
US

V. Phone/Fax

Practice location:
  • Phone: 615-393-8826
  • Fax:
Mailing address:
  • Phone: 615-393-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number2T3426
License Number StateNM

VIII. Authorized Official

Name: LAURA TARANTINO
Title or Position: EVP
Credential:
Phone: 972-464-0022