Healthcare Provider Details

I. General information

NPI: 1437520962
Provider Name (Legal Business Name): BOSQUE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5436 TECAMEC RD NE
RIO RANCHO NM
87144-3297
US

IV. Provider business mailing address

5436 TECAMEC RD NE
RIO RANCHO NM
87144-3297
US

V. Phone/Fax

Practice location:
  • Phone: 505-410-5648
  • Fax:
Mailing address:
  • Phone: 505-410-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0092241
License Number StateNM

VIII. Authorized Official

Name: MS. ANNETTE MUNOZ
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 505-503-6838