Healthcare Provider Details

I. General information

NPI: 1003031436
Provider Name (Legal Business Name): FAMILIES & YOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S. SOLANO DRIVE
LAS CRUCES NM
88001-3758
US

IV. Provider business mailing address

PO BOX 1868
LAS CRUCES NM
88004-1868
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-4004
  • Fax: 505-522-9017
Mailing address:
  • Phone: 505-522-4004
  • Fax: 505-522-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1077A
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN KAVANAUGH
Title or Position: CEO
Credential: MPA
Phone: 575-644-0485