Healthcare Provider Details

I. General information

NPI: 1275680589
Provider Name (Legal Business Name): CAMPO BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N MESILLA ST
LAS CRUCES NM
88005-2566
US

IV. Provider business mailing address

424 N MESILLA ST
LAS CRUCES NM
88005-2566
US

V. Phone/Fax

Practice location:
  • Phone: 505-525-8250
  • Fax: 505-647-2543
Mailing address:
  • Phone: 505-525-8250
  • Fax: 505-647-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number8136
License Number StateNM

VIII. Authorized Official

Name: MR. DEREK JONES REED
Title or Position: CFO
Credential:
Phone: 505-525-8250