| Prospera Healthcare New Mexico Llc | |
|
9701 Montgomery Blvd Ne Albuquerque NM 87111-3501 | |
| (972) 900-2488 | |
| Not Available |
| Full Name | Prospera Healthcare New Mexico Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9701 Montgomery Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Kyle Coddington (FOUNDER) |
| Authorized Official Contact | 9724001983 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospera Healthcare New Mexico Llc 5200 Saddle Dr Flower Mound TX 75028-6011 Ph: () - | Prospera Healthcare New Mexico Llc 9701 Montgomery Blvd Ne Albuquerque NM 87111-3501 Ph: (972) 900-2488 |
| NPI Number | 1083363295 |
|---|---|
| Provider Enumeration Date | 03/23/2022 |
| Last Update Date | 03/23/2022 |
| Certification Date | 03/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083363295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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