=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376606186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUTH & FAMILY CENTERED SERVICES OF NM, INC DBA DESERT HILLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5310 SEQUOIA RD NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-836-7330
-----------------------------------------------------
Fax | 505-836-7424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5310 SEQUOIA RD NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-836-7330
-----------------------------------------------------
Fax | 505-836-7424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MISS CAROL BICKELMAN
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 505-836-7330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number | 1014A,4406,
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------