Healthcare Provider Details

I. General information

NPI: 1124466446
Provider Name (Legal Business Name): SHEKINAH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 06/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S WYOMING AVE
ROSWELL NM
88203-2326
US

IV. Provider business mailing address

3001 S WYOMING AVE
ROSWELL NM
88203-2326
US

V. Phone/Fax

Practice location:
  • Phone: 575-578-9450
  • Fax:
Mailing address:
  • Phone: 575-578-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN ARTHUR ANAYA
Title or Position: CEO
Credential: MA
Phone: 575-578-9450