MEDICARE: YOUTH & FAMILY CENTERED SERVICES OF NM, INC DBA DESERT HILLS

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility	1014A,4406,	NM

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1376606186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH & FAMILY CENTERED SERVICES OF NM, INC DBA DESERT HILLS

Provider Business Mailing Address
First Line	:	5310 SEQUOIA RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1249
Country	:	US
Telephone Number	:	505-836-7330
Fax Number	:	505-836-7424

Provider Business Practice Location Address
First Line	:	5310 SEQUOIA RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1249
Country	:	US
Telephone Number	:	505-836-7330
Fax Number	:	505-836-7424

Authorized Official
Title or Position	:	CEO
Name	:	MISS CAROL BICKELMAN
Credential	:	LPCC
Telephone Number	:	505-836-7330

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841