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General NPI Number Information
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NPI Number | 1730945593
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Entity Type | Organization
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Legal Business Name | ZION HEALING NM, LLC
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 4001 N. BUTLER AVE STE 3101
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City | FARMINGTON
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State | NM
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Zip | 87401-2365
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Country | US
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Telephone | 505-215-9639
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 N. BUTLER AVE STE 3101
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City | FARMINGTON
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State | NM
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Zip | 87401-2365
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Country | US
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Telephone | 505-215-9639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MYLENE RAE MANNING
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Credential |
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Telephone | 505-215-9639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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