Healthcare Provider Details

I. General information

NPI: 1447902192
Provider Name (Legal Business Name): MAKING AN IMPACT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MONTERREY RD NE
RIO RANCHO NM
87144-5600
US

IV. Provider business mailing address

8601 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5775
US

V. Phone/Fax

Practice location:
  • Phone: 719-651-7584
  • Fax:
Mailing address:
  • Phone: 719-651-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BROOKE SGUARDO
Title or Position: VP
Credential:
Phone: 480-299-2385