OUR LADY OF MOUNT CARMEL NPI 1962569640

NPI Information

NPI: 1962569640
Provider Name: OUR LADY OF MOUNT CARMEL
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
300 MOUNT CARMEL AVE
GALLUP, NM
ZIP 87301
Phone: (505) 722-9411
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OUR LADY OF MOUNT CARMEL is a residential treatment facility emotionally disturbed children in Gallup, NM. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. OUR LADY OF MOUNT CARMEL NPI is 1962569640. The provider is registered as an organization entity type.

The provider's business location address is:

300 MOUNT CARMEL AVE
GALLUP, NM
ZIP 87301-411
Phone: (505) 722-9411

The provider's authorized official is Rose Marie Holden .
The authorized official title is Administrator and has the following contact phone number (505) 722-9411.

The enumeration date for this NPI number is 1/2/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		RTC#4372	NEW MEXICO	Yes
2	323P00000X	Psychiatric Residential Treatment Facility		RTC#4372	NEW MEXICO	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	VNM30195	OTHER	NEW MEXICO	VALUE OPTIONS VENDOR ID
2	M1001	MEDICAID	NEW MEXICO
3	NM600391	OTHER	NEW MEXICO	VALUE OPTIONS PROVIDER #
4	RTC#4372	OTHER	NEW MEXICO	STATE OF NM LICENSE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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