Healthcare Provider Details

I. General information

NPI: 1730945593
Provider Name (Legal Business Name): ZION HEALING NM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N. BUTLER AVE STE 3101
FARMINGTON NM
87401-2365
US

IV. Provider business mailing address

4001 N. BUTLER AVE STE 3101
FARMINGTON NM
87401-2365
US

V. Phone/Fax

Practice location:
  • Phone: 505-215-9639
  • Fax:
Mailing address:
  • Phone: 505-215-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYLENE RAE MANNING
Title or Position: OWNER
Credential:
Phone: 505-215-9639