Healthcare Provider Details

I. General information

NPI: 1609657519
Provider Name (Legal Business Name): CHIRON'S CAVE HOLISTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 GOLF COURSE RD SE STE A
RIO RANCHO NM
87124-1764
US

IV. Provider business mailing address

2103 GOLF COURSE RD SE STE A
RIO RANCHO NM
87124-1764
US

V. Phone/Fax

Practice location:
  • Phone: 541-919-4404
  • Fax: 541-248-1147
Mailing address:
  • Phone: 541-919-4404
  • Fax: 541-248-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRIS M LOMBARDO
Title or Position: OWNER
Credential: LPCC
Phone: 541-919-4404