Healthcare Provider Details

I. General information

NPI: 1275307613
Provider Name (Legal Business Name): VANGUARD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 TULANE DR NE
ALBUQUERQUE NM
87107-4486
US

IV. Provider business mailing address

3655 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1644
US

V. Phone/Fax

Practice location:
  • Phone: 866-425-1912
  • Fax:
Mailing address:
  • Phone: 928-671-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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