1538550702 NPI number — HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE LLC

Table of content: (NPI 1538550702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538550702 NPI number — HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538550702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3102 WEST END AVENUE
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-393-8800
Provider Business Mailing Address Fax Number:
615-393-8844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 GIBSON BLVD. SE
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-4763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-254-4500
Provider Business Practice Location Address Fax Number:
505-266-0838
Provider Enumeration Date:
02/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PICKLE
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/COMPTROLLER
Authorized Official Telephone Number:
615-393-8809

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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