Healthcare Provider Details

I. General information

NPI: 1033809256
Provider Name (Legal Business Name): NEW MEXICO BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 RANDOLPH RD SE
ALBUQUERQUE NM
87106-4230
US

IV. Provider business mailing address

1801 RANDOLPH RD SE
ALBUQUERQUE NM
87106-4230
US

V. Phone/Fax

Practice location:
  • Phone: 702-595-2995
  • Fax:
Mailing address:
  • Phone: 702-595-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: THI HOANG
Title or Position: BILLING AGENT
Credential:
Phone: 702-205-8232