Healthcare Provider Details

I. General information

NPI: 1316779598
Provider Name (Legal Business Name): HARMONY HAVEN PSYCHIATRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 1ST ST NW
ALBUQUERQUE NM
87102-2306
US

IV. Provider business mailing address

10232 COUNTRY SAGE DR NW # ABQ
ALBUQUERQUE NM
87114-3515
US

V. Phone/Fax

Practice location:
  • Phone: 954-451-8444
  • Fax:
Mailing address:
  • Phone: 109-544-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOVETTE AGATHA AGBOMMA NDUBISI
Title or Position: PMHNP-BC/PROVIDER
Credential: NP
Phone: 954-451-8444