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General NPI Number Information
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NPI Number | 1679839963
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Entity Type | Organization
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Legal Business Name | HIGH DESERT FAMILY SERVICES
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 7001 PROSPECT PL NE STE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4315
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Country | US
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Telephone | 505-823-4530
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Fax | 505-823-4538
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Provider Business Mailing Address
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Address Line | 7001 PROSPECT PL NE STE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DENNIS JAMES
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Credential | LISW
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Telephone | 505-823-4530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | T-0147511
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License Number State | NM
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