| Organization Name: | DESERT VISTA COUNSELING AND BEHAVIORAL HEALTH SERVICE LLC |
| NPI Number: | 1710259668 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GUILLERMO GOMEZ (CEO) |
| Mailing Address: | 229 Angelina Chaparral |
| State: | NM US |
| Postal Code: | 880817558 |
| Phone Number: | 9153550497 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2012 |
| NPI Last Update Date: | 02/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 251800000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |