| Spirit Of Hope, Llc | |
|
1637 Old Us 66 Edgewood NM 87015 | |
| (505) 750-2743 | |
| Not Available |
| Full Name | Spirit Of Hope, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1637 Old Us 66, Edgewood, New Mexico |
| Authorized Official Name and Position | Kara Shrader (OWNER) |
| Authorized Official Contact | 5057502743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spirit Of Hope, Llc Po Box 9 Edgewood NM 87015-0009 Ph: (505) 750-2743 | Spirit Of Hope, Llc 1637 Old Us 66 Edgewood NM 87015 Ph: (505) 750-2743 |
| NPI Number | 1174282909 |
|---|---|
| Provider Enumeration Date | 12/09/2021 |
| Last Update Date | 01/03/2022 |
| Certification Date | 01/03/2022 |
| Medicare PECOS PAC ID | 1355791088 |
|---|---|
| Medicare Enrollment ID | O20231221001310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174282909 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kara Nicole Shrader |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376028035 PECOS PAC ID: 2264882992 Enrollment ID: I20231221001439 |
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