Provider Demographics
NPI:1093079303
Name:HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE, LLC
Other - Org Name:HAVEN BEHAVIORAL HOSPITAL OF ALBUQUERQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-9064
Mailing Address - Street 1:3102 W END AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1301
Mailing Address - Country:US
Mailing Address - Phone:615-393-8826
Mailing Address - Fax:
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4729
Practice Address - Country:US
Practice Address - Phone:615-393-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2T3426283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08652856Medicaid
NM324013Medicare Oscar/Certification