Healthcare Provider Details

I. General information

NPI: 1194530881
Provider Name (Legal Business Name): HEAVENLEIGH HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE BLDG F
ALBUQUERQUE NM
87110-1359
US

IV. Provider business mailing address

2921 CARLISLE BLVD NE STE 111-112
ALBUQUERQUE NM
87110-2865
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-4252
  • Fax:
Mailing address:
  • Phone: 505-539-5290
  • Fax: 888-503-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAKEITHA C BURTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 505-539-5290