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Contact Information

SANDIA CREST MENTAL HEALTH LLC
1701 US ROUTE 66
SUITE D
MORIARTY, NM87035
 Phone: 505-384-1034
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
 

Psychiatric/Mental Health, Child & Adolescent

364SP0807X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for SANDIA CREST MENTAL HEALTH LLC

NPI Number 1932373743
LBN Legal business name SANDIA CREST MENTAL HEALTH LLC
Authorized official EDWARD LOBAUGH - (OWNDER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/14/2008
Last updated 09/19/2012 - About 14 years ago
Identifiers
NM License # R45675
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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