Organization
DESERT HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GATES (EXECUTIVE DIRECTOR)
(575) 571-1016
Entity
Organization
Contact information
Practice address
225 E IDAHO AVE STE 25, LAS CRUCES, NM 88005-3242
(575) 571-1016
Mailing address
PO BOX 1676, FAIRACRES, NM 88033-1676
(575) 571-1016
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
311Z00000X
Custodial Care Facility
—
—
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/26/2018
Last updated
11/28/2018
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