1568517753 NPI number — NAVA DRUG & ALCOHOL

Table of content: (NPI 1568517753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568517753 NPI number — NAVA DRUG & ALCOHOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVA DRUG & ALCOHOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NAVA COUNSELING SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568517753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88004-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-524-2505
Provider Business Mailing Address Fax Number:
505-524-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 E IDAHO AVE STE 4B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-524-2505
Provider Business Practice Location Address Fax Number:
505-524-2504
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
LEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND DIRECTOR
Authorized Official Telephone Number:
505-524-2505

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM600345 . This is a "VALUEOPTIONS PROVIDER ID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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