Organization
CHILDREN'S TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE ANN DOZZO PHD (CLINICAL DIRECTOR)
(505) 296-3965
Entity
Organization
Contact information
Practice address
6611 GULTON CT NE, ALBUQUERQUE, NM 87109-4407
(505) 296-3965
(505) 323-9430
Mailing address
6611 GULTON CT NE, ALBUQUERQUE, NM 87109-4407
(505) 296-3965
(505) 323-9430
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
CU00006637
NM
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
CU00006637
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M1855
—
NM
05
—
M1919
—
NM
01
—
NM600109
VALUE OPTIONS
NM
Enumeration date
10/20/2005
Last updated
07/22/2014
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