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General NPI Number Information
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NPI Number | 1831998988
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Entity Type | Organization
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Legal Business Name | MESA LUNA RECOVERY, LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 620 ROMA AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2037
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Country | US
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Telephone | 505-362-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 620 ROMA AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2037
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Country | US
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Telephone | 505-243-5762
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY HOLLAND
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Credential | LCSW
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Telephone | 505-261-8715
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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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