MEDICARE: UNLIMITED POTENTIAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1457105835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED POTENTIAL, LLC

Provider Business Mailing Address
First Line	:	4146 CALLE DE LUNA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7635
Country	:	US
Telephone Number	:	575-621-2573
Fax Number	:

Provider Business Practice Location Address
First Line	:	4146 CALLE DE LUNA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7635
Country	:	US
Telephone Number	:	575-621-2573
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	RUTH ROMAN
Credential	:
Telephone Number	:	575-621-2573

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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Directions to “UNLIMITED POTENTIAL, LLC ” Practice Location

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