Healthcare Provider Details

I. General information

NPI: 1114916319
Provider Name (Legal Business Name): NEW MEXICO BEHAVIORAL HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 HOT SPRINGS BLVD
LAS VEGAS NM
87701-9549
US

IV. Provider business mailing address

3695 HOT SPRINGS BLVD
LAS VEGAS NM
87701-9549
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-2190
  • Fax: 505-454-2222
Mailing address:
  • Phone: 505-454-2190
  • Fax: 505-454-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5067
License Number StateNM

VIII. Authorized Official

Name: MR. WILLIAM CHALTRY
Title or Position: NURSING HOME ADMINISTRATOR
Credential: NHA
Phone: 505-454-2190