Provider Demographics
NPI:1518328046
Name:ANDRE ARMENTA GRIEF & HEALING CENTER, LLC
Entity Type:Organization
Organization Name:ANDRE ARMENTA GRIEF & HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:ARMENTA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-263-2947
Mailing Address - Street 1:6300 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2617
Mailing Address - Country:US
Mailing Address - Phone:505-796-9600
Mailing Address - Fax:
Practice Address - Street 1:6300 RIVERSIDE PLAZA LN NW
Practice Address - Street 2:SUITE 125
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2617
Practice Address - Country:US
Practice Address - Phone:505-796-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-061371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty