Healthcare Provider Details

I. General information

NPI: 1164585436
Provider Name (Legal Business Name): A NEW AWAKENING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST NW SUITE 200
ALBUQUERQUE NM
87102-2311
US

IV. Provider business mailing address

600 1ST ST NW SUITE 200
ALBUQUERQUE NM
87102-2311
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9124
  • Fax: 505-247-9503
Mailing address:
  • Phone: 505-224-9124
  • Fax: 505-247-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MAHENDER P SINGH
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 505-224-9124