Healthcare Provider Details

I. General information

NPI: 1568838795
Provider Name (Legal Business Name): COURAGEOUS TRANSFORMATIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 LOS ARBOLES AVE NE
ALBUQUERQUE NM
87107-1943
US

IV. Provider business mailing address

PO BOX 35014
ALBUQUERQUE NM
87176-5014
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7092
  • Fax:
Mailing address:
  • Phone: 505-800-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberNM10061M
License Number StateNM

VIII. Authorized Official

Name: CHARLOTTE BREEDEN
Title or Position: CEO/DIRECTOR
Credential: RPH
Phone: 505-800-7092