Healthcare Provider Details

I. General information

NPI: 1891892014
Provider Name (Legal Business Name): HALVORSON HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N BEHREND AVE
FARMINGTON NM
87401-8448
US

IV. Provider business mailing address

PO BOX 15067
FARMINGTON NM
87401-5067
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1079A
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1079A
License Number StateNM

VIII. Authorized Official

Name: TAMI LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-326-2736