Healthcare Provider Details

I. General information

NPI: 1235996232
Provider Name (Legal Business Name): HGU ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE STE 103
RIO RANCHO NM
87124-4732
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE STE 103
RIO RANCHO NM
87124-4732
US

V. Phone/Fax

Practice location:
  • Phone: 505-410-9548
  • Fax:
Mailing address:
  • Phone: 505-410-9548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY ANNE LEWIS
Title or Position: CEO
Credential: MA LPCC
Phone: 505-410-9548