Healthcare Provider Details

I. General information

NPI: 1487084885
Provider Name (Legal Business Name): HEART PATH HELPERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SUMMER AVE NE
ALBUQUERQUE NM
87110-6738
US

IV. Provider business mailing address

10916 MILKY WAY ST NW
ALBUQUERQUE NM
87114-1542
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-8777
  • Fax:
Mailing address:
  • Phone: 505-463-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05107
License Number StateNM

VIII. Authorized Official

Name: SUZANNE BEAUCAGE
Title or Position: LISW
Credential:
Phone: 505-463-8777