Provider Demographics
NPI:1073968749
Name:EL PASO COMMUNITY MHMR
Entity Type:Organization
Organization Name:EL PASO COMMUNITY MHMR
Other - Org Name:EMERGENCE HEALTH NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-603-8045
Mailing Address - Street 1:1600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5622
Mailing Address - Country:US
Mailing Address - Phone:915-877-3410
Mailing Address - Fax:915-351-4708
Practice Address - Street 1:1600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5622
Practice Address - Country:US
Practice Address - Phone:915-877-3410
Practice Address - Fax:915-351-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127376505Medicaid
TXOOBM29Medicare PIN