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General NPI Number Information
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NPI Number | 1750448056
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Entity Type | Organization
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Legal Business Name | LA VIDA FELICIDAD, INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 530 SUN RANCH VILLAGE LOOP SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-4809
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Country | US
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Telephone | 505-565-1614
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Fax | 505-565-1608
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Provider Business Mailing Address
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Address Line | PO BOX 2040
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City | LOS LUNAS
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State | NM
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Zip | 87031-2040
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Country | US
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Telephone | 505-565-1614
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Fax | 505-565-1608
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | MR. MARTIN ISAIAS MONDRAGON
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Credential |
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Telephone | 505-565-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 5604
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License Number State | NM
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