Healthcare Provider Details

I. General information

NPI: 1114475084
Provider Name (Legal Business Name): NEW LIFE BIRTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 02/24/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 BALSA COURT NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

320 GOLD AVE SW, STE 620 PMB 1305
ALBUQUERQUE NM
87102-3210
US

V. Phone/Fax

Practice location:
  • Phone: 505-375-4433
  • Fax:
Mailing address:
  • Phone: 505-375-4433
  • 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: MJ MONTOYA
Title or Position: MANAGING PARTNER
Credential: MBA
Phone: 505-375-4433