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General NPI Number Information
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NPI Number | 1285351759
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Entity Type | Organization
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Legal Business Name | BCH ADDICTION & TREATMENT CENTER
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 2921 CARLISLE BLVD NE STE 125
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-2865
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Country | US
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Telephone | 505-554-1659
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Fax |
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Provider Business Mailing Address
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Address Line | 2921 CARLISLE BLVD NE STE 125
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-2865
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Country | US
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Telephone | 505-554-1659
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | LAKEITHA CHARMAINE BURTON
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Credential |
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Telephone | 505-539-5290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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