Healthcare Provider Details

I. General information

NPI: 1912769738
Provider Name (Legal Business Name): SACRED TRANSITIONS NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD STE 10
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

44 LAMY DOWNS
LAMY NM
87540-9647
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-6728
  • Fax:
Mailing address:
  • Phone:
  • 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: AMY ELIZABETH ELMQUIST
Title or Position: MANAGER
Credential: LCSW
Phone: 505-216-6728