Healthcare Provider Details

I. General information

NPI: 1952240137
Provider Name (Legal Business Name): SOULFUL RECOVERY NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 20TH ST
DENVER CO
80201-2149
US

IV. Provider business mailing address

951 20TH ST PO 2149
DENVER CO
80201-2149
US

V. Phone/Fax

Practice location:
  • Phone: 908-510-8138
  • Fax:
Mailing address:
  • Phone: 908-510-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRANT SCHAEFER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 908-510-8138