Healthcare Provider Details

I. General information

NPI: 1821575671
Provider Name (Legal Business Name): LA VENTANA BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 12/10/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE A
LAS CRUCES NM
88001-3117
US

IV. Provider business mailing address

1990 E LOHMAN AVE STE A
LAS CRUCES NM
88001-3117
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4602
  • Fax: 575-522-2263
Mailing address:
  • Phone: 575-522-4602
  • Fax: 575-522-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCNP-02160
License Number StateNM

VIII. Authorized Official

Name: MS. LORENA GARCIA
Title or Position: PROVIDER/OWNER
Credential: CNP
Phone: 575-522-4602