Basic Information
| Provider Information | |||||||||
| NPI: | 1720094550 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH AND HUMAN SERVICES COMMISSION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | EL PASO PSYCHIATRIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 ALAMEDA AVENUE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155322202 | ||||||||
| FaxNumber: | 9155345509 | ||||||||
| Practice Location | |||||||||
| Address1: | 4615 ALAMEDA AVENUE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155322202 | ||||||||
| FaxNumber: | 9155345509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GARNETT | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5124385618 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | TX | N | Hospitals | Psychiatric Hospital | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1127516-04 | 05 | TX | MEDICAID | 1127516-01 | 05 | TX | MEDICAID | 4539118 | 01 | TX | PHARMACY NCPDP NUMBER | OTHER | 1127516-05 | 05 | TX | MEDICAID | HH0938 | 01 | TX | BCBS PSYCHIATRIC | OTHER | 1127516-03 | 05 | TX | MEDICAID |