Provider Demographics
NPI:1538550702
Name:HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE LLC
Entity type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF ALBUQUERQUE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-393-8809
Mailing Address - Street 1:3102 WEST END AVENUE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:615-393-8800
Mailing Address - Fax:615-393-8844
Practice Address - Street 1:5400 GIBSON BLVD. SE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4763
Practice Address - Country:US
Practice Address - Phone:505-254-4500
Practice Address - Fax:505-266-0838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-10
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty