Healthcare Provider Details

I. General information

NPI: 1609422930
Provider Name (Legal Business Name): WINDMILL FIGHTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TIJERAS AVE NW STE A
ALBUQUERQUE NM
87102-3098
US

IV. Provider business mailing address

803 TIJERAS AVE NW STE A
ALBUQUERQUE NM
87102-3098
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2223
  • Fax: 505-243-3576
Mailing address:
  • Phone: 505-243-2223
  • Fax: 505-243-3576

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: MR. GARRY INSTITUTE HALLFORD
Title or Position: DIRECTOR
Credential: LMHC
Phone: 505-243-2223