MEDICARE: THE LEGEND OF HOPE PSYCHIATRY 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72600	OTHER	NM	NEW MEXICO BOARD OF NURSING

General Provider Information

NPI Number	:	1780573022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LEGEND OF HOPE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	1811 LEAD AVE SE APT 16
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4076
Country	:	US
Telephone Number	:	877-416-6474
Fax Number	:	505-355-2684

Provider Business Practice Location Address
First Line	:	1811 LEAD AVE SE APT 16
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4076
Country	:	US
Telephone Number	:	505-549-7920
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE ELMAN
Credential	:
Telephone Number	:	877-416-6474

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	03/02/2026

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