Healthcare Provider Details

I. General information

NPI: 1639028020
Provider Name (Legal Business Name): MAKING AN IMPACT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 EUBANK BLVD NE
ALBUQUERQUE NM
87111-4860
US

IV. Provider business mailing address

8601 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5775
US

V. Phone/Fax

Practice location:
  • Phone: 505-305-0902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BROOKE SGUARDO
Title or Position: VP
Credential:
Phone: 480-299-2385