Healthcare Provider Details

I. General information

NPI: 1902727019
Provider Name (Legal Business Name): SOULSHINE AT NATIVE HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GLORY LN
ESTANCIA NM
87016-9738
US

IV. Provider business mailing address

2 GLORY LN
ESTANCIA NM
87016-9738
US

V. Phone/Fax

Practice location:
  • Phone: 813-263-6035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIAH LOWERY
Title or Position: OWNER/ ADMINISTRATOR
Credential: RN
Phone: 813-263-6036