Healthcare Provider Details

I. General information

NPI: 1861293268
Provider Name (Legal Business Name): JARDIN DE VIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MCNUTT RD STE 105
SUNLAND PARK NM
88063-9176
US

IV. Provider business mailing address

1155 MCNUTT RD STE 105
SUNLAND PARK NM
88063-9176
US

V. Phone/Fax

Practice location:
  • Phone: 575-332-9086
  • Fax: 575-332-9132
Mailing address:
  • Phone: 575-332-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA J GARCIA
Title or Position: CEO
Credential:
Phone: 575-332-9086