| Life Re-created Llc | |
|
3939 San Pedro Dr. Ne Bld C, Ste 8 Albuquerque NM 87110 | |
| (505) 369-6756 | |
| (505) 393-5201 |
| Full Name | Life Re-created Llc |
|---|---|
| Speciality | Counselor |
| Location | 3939 San Pedro Dr. Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Cathryn Ana Glenday (OWNER) |
| Authorized Official Contact | 5053696756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Re-created Llc Po Box 8946 C/o Cathryn Glenday Albuquerque NM 87198-8946 Ph: (505) 369-6756 | Life Re-created Llc 3939 San Pedro Dr. Ne Bld C, Ste 8 Albuquerque NM 87110 Ph: (505) 369-6756 |
| NPI Number | 1033770904 |
|---|---|
| Provider Enumeration Date | 06/21/2019 |
| Last Update Date | 07/18/2024 |
| Medicare PECOS PAC ID | 1153868534 |
|---|---|
| Medicare Enrollment ID | O20240802001501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033770904 | NPI | - | NPPES |
| 9673365 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Cathryn Ana Glenday |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477006815 PECOS PAC ID: 2062959448 Enrollment ID: I20240802001895 |
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