Organization
CHILDHAVEN, INC
Active
Organization
CHILDHAVEN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEAN CPA (CFO)
(505) 325-5358
Entity
Organization
Contact information
Practice address
807 W. APACHE ST., FARMINGTON, NM 87401
(505) 325-5358
(505) 327-1482
Mailing address
807 W. APACHE ST., FARMINGTON, NM 87401
(505) 325-5358
(505) 327-1482
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
CASE MANAGEMENT
NM
251S00000X
Community/Behavioral Health Agency
4151
NM
251S00000X
Community/Behavioral Health Agency
TREATMENT FOSTER CAR
NM
253J00000X
Foster Care Agency
Primary
4151
NM
253J00000X
Foster Care Agency
TREATMENTFOSTER CARE
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21138761
MEDICAID
NM
05
—
K3385
—
NM
Enumeration date
10/23/2006
Last updated
07/10/2014
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