Healthcare Provider Details

I. General information

NPI: 1922504117
Provider Name (Legal Business Name): HEART & SOUL OF NM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EAST RIVER RD APT B
BELEN NM
87002
US

IV. Provider business mailing address

PO BOX 292
TOME NM
87060-0292
US

V. Phone/Fax

Practice location:
  • Phone: 505-967-9974
  • Fax:
Mailing address:
  • Phone: 505-967-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: IGNACIO CASTILLO
Title or Position: PRESIDENT
Credential:
Phone: 505-967-9974