Healthcare Provider Details

I. General information

NPI: 1093498388
Provider Name (Legal Business Name): WINGS FOR LIFE INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2615
US

IV. Provider business mailing address

2051 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2615
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-4359
  • Fax:
Mailing address:
  • Phone: 505-226-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAX BARNETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-389-7129