Healthcare Provider Details

I. General information

NPI: 1073431151
Provider Name (Legal Business Name): ELIJAH FAMILY MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 NM 314
LOS LUNAS NM
87031
US

IV. Provider business mailing address

3 BLUE BONNET DR
LOS LUNAS NM
87031-6750
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-0403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER MONTANO
Title or Position: PRESIDENT
Credential:
Phone: 505-336-0403