Healthcare Provider Details

I. General information

NPI: 1598508152
Provider Name (Legal Business Name): FREE INDEED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 DESERT SAGE AVE SW
LOS LUNAS NM
87031-6577
US

IV. Provider business mailing address

3080 DESERT SAGE AVE SW
LOS LUNAS NM
87031-6577
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-2899
  • Fax:
Mailing address:
  • Phone: 505-804-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ONECIMO MIRABAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-804-2899