Provider Demographics
NPI:1124238266
Name:MESILLA VALLEY HOSPITAL
Entity type:Organization
Organization Name:MESILLA VALLEY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MST SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:TERESSA
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-202-2014
Mailing Address - Street 1:4115 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-0818
Mailing Address - Country:US
Mailing Address - Phone:505-202-2014
Mailing Address - Fax:
Practice Address - Street 1:4115 SENECA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-0818
Practice Address - Country:US
Practice Address - Phone:505-202-2014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06500251C00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered283Q00000XHospitalsPsychiatric Hospital