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General NPI Number Information
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NPI Number | 1043055916
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Entity Type | Organization
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Legal Business Name | SUMMIT BHC NEW MEXICO CTC, LLC
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1850 COPPER LOOP STE B
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City | LAS CRUCES
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State | NM
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Zip | 88005-8141
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Country | US
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Telephone | 888-727-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 1050-B COPPER LOOP
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City | LAS CRUCES
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State | NM
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Zip | 88005
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Country | US
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Telephone | 888-727-4770
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | PAUL GILBERT
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Credential |
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Telephone | 615-716-4924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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