Provider Demographics
NPI:1346310653
Name:TRIAD BEHAVIORAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:TRIAD BEHAVIORAL HEALTH CARE LLC
Other - Org Name:MILAGRO COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAFRENIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-1888
Mailing Address - Street 1:1401 S DON ROSER DR
Mailing Address - Street 2:SUITE F-1-2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4567
Mailing Address - Country:US
Mailing Address - Phone:575-521-4848
Mailing Address - Fax:575-522-1798
Practice Address - Street 1:1401 S DON ROSER DR
Practice Address - Street 2:SUITE F-1-2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4567
Practice Address - Country:US
Practice Address - Phone:575-521-4848
Practice Address - Fax:575-522-1798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD BEHAVIORAL HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-180251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty