Provider Demographics
NPI:1023894607
Name:FRONTERA HEALTH NEW MEXICO LLC
Entity type:Organization
Organization Name:FRONTERA HEALTH NEW MEXICO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMOL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHPANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-804-4440
Mailing Address - Street 1:1250 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4741
Mailing Address - Country:US
Mailing Address - Phone:575-288-1881
Mailing Address - Fax:575-288-1889
Practice Address - Street 1:1250 HILLRISE CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4741
Practice Address - Country:US
Practice Address - Phone:575-288-1881
Practice Address - Fax:575-288-1889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTERA HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-07
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty