Provider Demographics
NPI:1821575671
Name:LA VENTANA BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:LA VENTANA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-522-4602
Mailing Address - Street 1:1990 E LOHMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3117
Mailing Address - Country:US
Mailing Address - Phone:575-522-4602
Mailing Address - Fax:575-522-2263
Practice Address - Street 1:1990 E LOHMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3117
Practice Address - Country:US
Practice Address - Phone:575-522-4602
Practice Address - Fax:575-522-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02160261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79559247Medicaid