Provider Demographics
NPI:1093965873
Name:BERNALILLO COUNTY DEPARTMENT OF SUBSTANCE ABUSE PROGRAMS
Entity Type:Organization
Organization Name:BERNALILLO COUNTY DEPARTMENT OF SUBSTANCE ABUSE PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:BROACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-468-1553
Mailing Address - Street 1:5901 ZUNI RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3073
Mailing Address - Country:US
Mailing Address - Phone:505-468-1551
Mailing Address - Fax:505-266-3726
Practice Address - Street 1:5901 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3073
Practice Address - Country:US
Practice Address - Phone:505-468-1551
Practice Address - Fax:505-266-3726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERNALILLO COUNTY PUBLIC SAFETY DIVISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management