Provider Demographics
NPI:1114304136
Name:ARTESIA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ARTESIA GENERAL HOSPITAL
Other - Org Name:BEHAVIORAL HEALTH CLINIC - CARLSBAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-736-8116
Mailing Address - Street 1:702 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1166
Mailing Address - Country:US
Mailing Address - Phone:575-736-8116
Mailing Address - Fax:
Practice Address - Street 1:1101 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4014
Practice Address - Country:US
Practice Address - Phone:575-725-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARTESIA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health