Healthcare Provider Details

I. General information

NPI: 1275910101
Provider Name (Legal Business Name): HEALING ADDICTION IN OUR COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 CONDERSHIRE DR SW
ALBUQUERQUE NM
87121-5253
US

IV. Provider business mailing address

PO BOX 56632
ALBUQUERQUE NM
87187-6632
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-9684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER WEISS-BURKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-363-9684