Provider Demographics
NPI:1376754747
Name:MESILLA VALLEY HOSPITAL
Entity Type:Organization
Organization Name:MESILLA VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEINEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:505-382-3500
Mailing Address - Street 1:3751 DEL REY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7710
Mailing Address - Country:US
Mailing Address - Phone:505-382-3500
Mailing Address - Fax:
Practice Address - Street 1:3751 DEL REY BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7710
Practice Address - Country:US
Practice Address - Phone:505-382-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital