Healthcare Provider Details

I. General information

NPI: 1003604943
Provider Name (Legal Business Name): HEAL HERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 STAGECOACH RD SE
RIO RANCHO NM
87124-2329
US

IV. Provider business mailing address

480 STAGECOACH RD SE
RIO RANCHO NM
87124-2329
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-8695
  • Fax:
Mailing address:
  • Phone: 505-550-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SONYA PADILLA
Title or Position: OWNER
Credential: LCSW
Phone: 505-550-8695