Provider Demographics
NPI:1962612010
Name:MESILLA VALLEY HOSPITAL
Entity type:Organization
Organization Name:MESILLA VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MST THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:505-649-5415
Mailing Address - Street 1:209 RISTRA ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NM
Mailing Address - Zip Code:88048-9356
Mailing Address - Country:US
Mailing Address - Phone:505-882-2670
Mailing Address - Fax:
Practice Address - Street 1:209 RISTRA ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NM
Practice Address - Zip Code:88048-9356
Practice Address - Country:US
Practice Address - Phone:505-882-2670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01022051283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital