Healthcare Provider Details

I. General information

NPI: 1114509437
Provider Name (Legal Business Name): LIFESPHERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

5 BISBEE CT STE 109
SANTA FE NM
87508-1419
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-0693
  • Fax: 505-393-3070
Mailing address:
  • Phone: 505-983-0693
  • Fax: 505-393-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADONATA PYAGA
Title or Position: MANAGER
Credential:
Phone: 505-983-0693