Provider Demographics
NPI:1740490960
Name:MESILLA VALLEY HOSPITAL
Entity type:Organization
Organization Name:MESILLA VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:GOODHEART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:505-373-1865
Mailing Address - Street 1:635 WEINRICH RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4840
Mailing Address - Country:US
Mailing Address - Phone:505-373-1865
Mailing Address - Fax:
Practice Address - Street 1:635 WEINRICH RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4840
Practice Address - Country:US
Practice Address - Phone:505-373-1865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital