MEDICARE: HIGH DESERT FAMILY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	T-0147511	NM

General Provider Information

NPI Number	:	1679839963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH DESERT FAMILY SERVICES

Provider Business Mailing Address
First Line	:	7001 PROSPECT PL NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 PROSPECT PL NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4315
Country	:	US
Telephone Number	:	505-823-4530
Fax Number	:	505-823-4538

Authorized Official
Title or Position	:	CEO
Name	:	MR. DENNIS JAMES
Credential	:	LISW
Telephone Number	:	505-823-4530

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/11/2012

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