| Halvorson House, Inc. | |
|
108 N Behrend Ave Farmington NM 87401-8448 | |
| (505) 326-2736 | |
| Not Available |
| Full Name | Halvorson House, Inc. |
|---|---|
| Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
| Location | 108 N Behrend Ave, Farmington, New Mexico |
| Authorized Official Name and Position | Tami Lewis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5053262736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Halvorson House, Inc. Po Box 15067 Farmington NM 87401-5067 Ph: () - | Halvorson House, Inc. 108 N Behrend Ave Farmington NM 87401-8448 Ph: (505) 326-2736 |
| NPI Number | 1891892014 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891892014 | NPI | - | NPPES |
| M1925 | Medicaid | NM | |
| M0115 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1079A (New Mexico) | Primary |
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 1079A (New Mexico) | Primary |
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