Healthcare Provider Details

I. General information

NPI: 1942021738
Provider Name (Legal Business Name): RIGHTS OF PASSAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W ALAMEDA ST APT B3
SANTA FE NM
87507-9656
US

IV. Provider business mailing address

1000 CORDOVA PL PMB 65
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-1446
  • Fax:
Mailing address:
  • Phone: 505-660-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MALONE
Title or Position: TREASURER
Credential: J.D.
Phone: 202-861-1859