Healthcare Provider Details

I. General information

NPI: 1194150094
Provider Name (Legal Business Name): TURQUOISE HEALTH AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FIR ST
PORTALES NM
88130-5826
US

IV. Provider business mailing address

202 E EARLL DR SUITE 200
PHOENIX AZ
85012-2634
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-2223
  • Fax:
Mailing address:
  • Phone: 602-808-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DORIS VAUGHT
Title or Position: CFO
Credential:
Phone: 602-599-5420