Healthcare Provider Details

I. General information

NPI: 1437896644
Provider Name (Legal Business Name): GARDEN OF HOPE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 ASHFORD DR
CLOVIS NM
88101-4436
US

IV. Provider business mailing address

2504 ASHFORD DR
CLOVIS NM
88101-4436
US

V. Phone/Fax

Practice location:
  • Phone: 316-768-7991
  • Fax:
Mailing address:
  • Phone: 316-768-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BONIFACE GITAU
Title or Position: MANAGER
Credential: CERTIFIED NP
Phone: 316-768-7991