Provider Demographics
NPI:1386283869
Name:NEW AGE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:NEW AGE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-428-0039
Mailing Address - Street 1:3600 RODEO LN STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6400
Mailing Address - Country:US
Mailing Address - Phone:505-428-0039
Mailing Address - Fax:866-793-0501
Practice Address - Street 1:3600 RODEO LN STE 5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6400
Practice Address - Country:US
Practice Address - Phone:505-428-0039
Practice Address - Fax:866-793-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty