Provider Demographics
NPI:1275680589
Name:CAMPO BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CAMPO BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-525-8250
Mailing Address - Street 1:424 N MESILLA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2566
Mailing Address - Country:US
Mailing Address - Phone:505-525-8250
Mailing Address - Fax:505-647-2543
Practice Address - Street 1:424 N MESILLA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2566
Practice Address - Country:US
Practice Address - Phone:505-525-8250
Practice Address - Fax:505-647-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8136251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD1001Medicaid