Provider Demographics
NPI:1407990500
Name:NM DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:NM DEPARTMENT OF HEALTH
Other - Org Name:SEQUOYAH ADOLESCENT TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-222-0375
Mailing Address - Street 1:3405 W PAN AMERICAN FWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4786
Mailing Address - Country:US
Mailing Address - Phone:505-222-0300
Mailing Address - Fax:505-222-0301
Practice Address - Street 1:3405 PAN AMERICAN FWY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4786
Practice Address - Country:US
Practice Address - Phone:505-222-0300
Practice Address - Fax:505-222-0301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NM DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children