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General NPI Number Information
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NPI Number | 1144013103
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Entity Type | Organization
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Legal Business Name | CARLSBAD LIFEHOUSE INC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 259 BLUEBERRY HILL RD
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City | EL PRADO
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State | NM
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Zip | 87529-7305
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Country | US
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Telephone | 575-758-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 WESTRIDGE RD
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City | CARLSBAD
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State | NM
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Zip | 88220-3550
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Country | US
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Telephone | 575-302-8304
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | KIMBERLY SUSAN ROGGE-ROGERS
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Credential |
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Telephone | 575-302-8304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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