Provider Demographics
NPI:1457770653
Name:ALL NATIONS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:ALL NATIONS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSSW
Authorized Official - Phone:575-937-4743
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0620
Mailing Address - Country:US
Mailing Address - Phone:575-937-4743
Mailing Address - Fax:
Practice Address - Street 1:3916 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3974
Practice Address - Country:US
Practice Address - Phone:505-292-3655
Practice Address - Fax:505-298-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder