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General NPI Number Information
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NPI Number | 1669157079
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Entity Type | Organization
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Legal Business Name | THA SWEET LIFE 2 DPR INC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 4611 MENAUL BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3069
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Country | US
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Telephone | 505-441-0995
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Fax |
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Provider Business Mailing Address
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Address Line | 400 GOLD AVE SW # 702
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3283
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Country | US
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Telephone | 806-443-0816
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Fax |
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Authorized Official
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Title or Position | FOUNDER/ EXCECUTIVE DIRECTOR
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Name | MISS KAWANNA MORRIS
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Credential | CPSW, CCSS, CADAC
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Telephone | 806-443-0816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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