Provider Demographics
NPI:1255963898
Name:NEW HAVEN BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:NEW HAVEN BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NURSE PRA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-966-6681
Mailing Address - Street 1:122 SWEET GUM ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-0139
Mailing Address - Country:US
Mailing Address - Phone:817-966-6681
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE C1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3576
Practice Address - Country:US
Practice Address - Phone:505-884-7873
Practice Address - Fax:844-272-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health