Healthcare Provider Details

I. General information

NPI: 1386283869
Provider Name (Legal Business Name): NEW AGE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RODEO LN STE 5
SANTA FE NM
87507-6400
US

IV. Provider business mailing address

3600 RODEO LN STE 5
SANTA FE NM
87507-6400
US

V. Phone/Fax

Practice location:
  • Phone: 505-428-0039
  • Fax: 866-793-0501
Mailing address:
  • Phone: 505-428-0039
  • Fax: 866-793-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CARRO
Title or Position: OWNER
Credential:
Phone: 505-428-0039