Healthcare Provider Details

I. General information

NPI: 1629326673
Provider Name (Legal Business Name): NATIVE AMERICAN BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S SECOND ST SUITE A
GALLUP NM
87301-5862
US

IV. Provider business mailing address

1500 S SECOND ST SUITE A
GALLUP NM
87301-5862
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-0723
  • Fax:
Mailing address:
  • Phone: 505-879-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number1200002447
License Number StateNM

VIII. Authorized Official

Name: MS. HALEY LAUGHTER
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 505-879-0723