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General NPI Number Information
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NPI Number | 1417373689
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Entity Type | Organization
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Legal Business Name | OPEN HEARTS SUPPORTED LIVING
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 10023 CALABACILLAS CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5825
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Country | US
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Telephone | 505-897-7273
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Fax | 505-897-7273
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Provider Business Mailing Address
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Address Line | 10023 CALABACILLAS CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5825
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Country | US
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Telephone | 505-897-7273
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Fax | 505-897-7273
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Authorized Official
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Title or Position | PRESIDENT/ DIRECTOR
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Name | COURTNEY VICTORIA KNUTSON-JONES
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Credential | BA, PSYCHOLOGY
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Telephone | 505-897-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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