| Meridian Behavioral Health Inc | |
|
3539 Thaxton Ave Se Albuquerque NM 87106-1628 | |
| (505) 903-0927 | |
| Not Available |
| Full Name | Meridian Behavioral Health Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3539 Thaxton Ave Se, Albuquerque, New Mexico |
| Authorized Official Name and Position | Madeleine Wilson (PRESIDENT) |
| Authorized Official Contact | 5059030927 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Behavioral Health Inc 301 San Andres Ave Nw Albuquerque NM 87107-3950 Ph: (505) 903-0927 | Meridian Behavioral Health Inc 3539 Thaxton Ave Se Albuquerque NM 87106-1628 Ph: (505) 903-0927 |
| NPI Number | 1003458357 |
|---|---|
| Provider Enumeration Date | 10/08/2019 |
| Last Update Date | 10/08/2019 |
| Medicare PECOS PAC ID | 5597167270 |
|---|---|
| Medicare Enrollment ID | O20210719000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003458357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Madeleine Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316383540 PECOS PAC ID: 2668714569 Enrollment ID: I20190424002803 |
| Provider Name | Ricki Lee Bloom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588077416 PECOS PAC ID: 0941670640 Enrollment ID: I20221221000266 |
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