Healthcare Provider Details

I. General information

NPI: 1255174785
Provider Name (Legal Business Name): HOPE RISING NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11312 CANYONLANDS RD SE
ALBUQUERQUE NM
87123-5797
US

IV. Provider business mailing address

11312 CANYONLANDS RD SE
ALBUQUERQUE NM
87123-5797
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-0193
  • Fax:
Mailing address:
  • Phone: 505-280-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AUDRA HAYS
Title or Position: CLINICAL SOCIAL WORKER/OWNER
Credential: LCSW
Phone: 505-280-0193