Healthcare Provider Details

I. General information

NPI: 1154182590
Provider Name (Legal Business Name): PENNY'S PLAYCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO BLVD NE STE 203
RIO RANCHO NM
87124-1456
US

IV. Provider business mailing address

333 RIO RANCHO BLVD NE STE 203
RIO RANCHO NM
87124-1456
US

V. Phone/Fax

Practice location:
  • Phone: 505-659-5939
  • Fax:
Mailing address:
  • Phone: 505-205-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PENNY URBINA
Title or Position: OWNER AND CLINICAL DIRECTOR
Credential: LCSW
Phone: 505-659-5939