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General NPI Number Information
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NPI Number | 1841332400
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Entity Type | Organization
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Legal Business Name | THE LIFE LINK
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2325 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505-3373
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Country | US
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Telephone | 505-438-0010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6094
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City | SANTA FE
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State | NM
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Zip | 87502-6094
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Country | US
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Telephone | 505-438-0010
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Fax | 505-438-6011
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CAROLYN LUNA-ANDERSON
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Credential | PH.D.
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Telephone | 505-438-0010
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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 | 3026
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License Number State | NM
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