Healthcare Provider Details

I. General information

NPI: 1447007901
Provider Name (Legal Business Name): CEDAR CREEK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 MECHEM DR STE B
RUIDOSO NM
88345-6952
US

IV. Provider business mailing address

708 MECHEM DR STE B
RUIDOSO NM
88345-6952
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-0982
  • Fax: 575-454-3152
Mailing address:
  • Phone: 505-273-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY WARD
Title or Position: PRESIDENT
Credential: LCSW
Phone: 505-273-0982