Organization
OUR LADY OF MOUNT CARMEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MARIE HOLDEN NHA (ADMINISTRATOR)
(505) 722-9411
Entity
Organization
Contact information
Practice address
300 MOUNT CARMEL AVE, GALLUP, NM 87301-7411
(505) 722-9411
Mailing address
300 MOUNT CARMEL AVE, GALLUP, NM 87301-7411
(505) 722-9411
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
RTC#4372
NM
323P00000X
Psychiatric Residential Treatment Facility
Primary
RTC#4372
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M1001
—
NM
01
—
NM600391
VALUE OPTIONS PROVIDER #
NM
01
—
RTC#4372
STATE OF NM LICENSE #
NM
01
—
VNM30195
VALUE OPTIONS VENDOR ID
NM
Enumeration date
01/02/2007
Last updated
09/11/2025
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