Healthcare Provider Details

I. General information

NPI: 1457285215
Provider Name (Legal Business Name): ANGELS WITH BROKEN WINGS NM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E AMADOR AVE
LAS CRUCES NM
88001-3309
US

IV. Provider business mailing address

609 E AMADOR AVE
LAS CRUCES NM
88001-3309
US

V. Phone/Fax

Practice location:
  • Phone: 575-259-4124
  • Fax:
Mailing address:
  • Phone: 575-259-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS GINGER SHANNON
Title or Position: CEO/ PRESIDENT
Credential: CPSW, CCSS
Phone: 575-288-8766