Healthcare Provider Details

I. General information

NPI: 1427857457
Provider Name (Legal Business Name): INCLUSIVE&EMPOWERING LIVING HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 VIA COMETA SW
ALBUQUERQUE NM
87121-6326
US

IV. Provider business mailing address

11812 BADGER MOUNTAIN TRL NW
ALBUQUERQUE NM
87120-4366
US

V. Phone/Fax

Practice location:
  • Phone: 505-353-1153
  • Fax:
Mailing address:
  • Phone: 505-353-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC NDAHEBA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-353-1153